The differential diagnosis of acute abdomen in pregnancy is extensive. Anatomic and physiologic changes of pregnancy can alter the usual clinical presentation and fetal concerns influence the choice of diagnostic and therapeutic options. Prompt treatment is critical to successful management. Most elective and urgent operations can be performed during pregnancy with minimal maternal and fetal risk when appropriate precautions are taken. Use of USG, MRI, laparoscopy and other newer modalities has significantly influenced the diagnostic and therapeutic algorithms but evidence based management protocols are not yet established. Thus, a multiprofessional team approach with consultation and referral helps to optimize the management of acute abdomen in pregnancy which require dispartate areas of expertise. The condition of mother should always take priority because proper treatment of mother usually benefits the fetus as well.