Herniation of a gravid uterus through an abdominal wall incisional hernia with overlying skin necrosis is exceptionally rare. A 29-year-old multiparous K30 + 4/40 pregnant female presented with a 1-month history of worsening abdominal wall skin changes. Magnetic resonance imaging of the abdomen and pelvis confirmed herniation of the gravid uterus into the hernia sac. A lower uterine segment caesarean section and hernia repair were performed by the general surgical and obstetrics team in view of the potential maternofoetal complications. This case highlights the importance of early recognition and the difficulties in managing gravid uterus herniation.