Based on the Cullen's sign and the distended abdomen, I suspect internal hemorrhaging; in this case, maybe because of a ruptured ectopic pregnancy or trauma.
the Cullen's sign is obvious, the distention is extreme though, so that points to ascites (vs. hemorrhaging), most likely due to cirrhosis.
Yes, the distention is extreme; it cannot be from a bleed alone (if she's still alive, that is). The Cullen's sign proves there has to be a bleed, but either she has two unrelated conditions (e.g. condition A (resulting in ascites) and B (causing hemorrhaging)) or I don't know a condtion that is likely to cause both.