We report on 2 cases of neonatal bladder rupture that resulted from umbilical artery manipulation. This rare complication occurs because of the close proximity of the urachus to the umbilical arteries and peritoneal reflection, and results in urinary ascites and respiratory compromise. Among 11 neonates in the literature who experienced this complication the mortality rate was 18% but all 8 neonates who underwent surgical repair, including our 2 patients, survived.