BACKGROUND Pubic symphysis rupture significant enough to cause serious complications or require surgical intervention is exceedingly rare. Here we review the literature and examine the details of a unique presentation. CASE A 27-year-old woman presented in labour at 34+6 weeks gestation after an uncomplicated monochorionic-diamniotic twin pregnancy. After vaginal delivery, she developed a substantial labial hematoma. Hours later, she became hemodynamically unstable. Imaging revealed a 4.7-cm pubic diastasis and a small arterial tear. One week later, the diastasis had expanded to 6 cm on X-ray. As a result, the patient underwent surgical intervention. She was discharged home on postpartum day 21 and remained non-weight-bearing for 8 weeks. CONCLUSION Pubic symphysis rupture is a potentially life-threatening obstetrical complication that requires early recognition and effective multidisciplinary care.