The second surviving patient who sustained spontaneous rupture of a renal artery aneurysm during pregnancy is presented. Awareness that these aneurysms rupture more commonly during pregnancy will result in early diagnosis and adequate therapy, hopefully reducing maternal mortality. To find these aneurysms before they rupture, arteriography should be used more frequently in the workup of patients who develop hypertension or who have abdominal bruits. Nephrectomy is indicated in the presence of massive renal or retroperitoneal hemorrhage during pregnancy, even when the source of bleeding cannot be definitely ascertained.