Small (2 to 3 cm) asymptomatic splenic artery aneurysms are likely to be recognized incidentally in an increasing number of women undergoing abdominal imaging for other conditions. Such aneurysms can be monitored closely for symptoms or expansion unless the woman is in the child-bearing age or pregnant. These younger women need aneurysm obliteration before catastrophic rupture occurs during pregnancy. Those physicians and nurse practitioners who manage pregnant women must be cognizant and vigilant of the prodromal and catastrophic symptoms of splenic artery aneurysm. Early recognition and expeditious therapy remain the keys to saving both the mother and fetus. The current therapeutic menu now includes surgery, catheter embolization, or laparoscopic ligation. The final choice or combination of options will depend on the anatomy of the aneurysm, the medical condition of the patient, and the availability and skill of those who can perform the interventions.