A 32-year-old multigravid patient at 21 weeks gestation presents with major 
concealed placental abruption and subsequent fetal demise. During an eventually 
failed misoprostol regime aiming for vaginal delivery she develops severe 
disseminated intravascular coagulopathy. Subsequent hysterotomy reveals 
Couvelaire uterus with major haemorrhage and requires subtotal hysterectomy for 
haemostasis. This case highlights the severity of the systemic response to 
abruption and fetal demise in utero and the multifactorial nature of its 
management.