Hidden Preeclampsia Leading to Placental Abruption and Disseminated Intravascular Coagulation

Placental abruption is a life-threatening obstetric emergency, often associated with hypertensive disorders such as preeclampsia. This study describes a 28-year-old multiparous woman at 36 weeks and four days of gestation who presented with contractions without any overt signs of preeclampsia. Despite an initial blood pressure of 130/85 mmHg, fetal bradycardia and uterine tachysystole prompted an emergency cesarean section. Intraoperative findings confirmed placental abruption, and postoperative laboratory results revealed significant proteinuria, confirming undiagnosed preeclampsia. Postpartum complications included severe hemorrhage exceeding 2000 mL, progressing to disseminated intravascular coagulation (DIC), which required aggressive resuscitation, a massive transfusion protocol, and intensive care management. This case emphasized the challenge of diagnosing "hidden" preeclampsia, the variability of placental abruption presentations, and the importance of early recognition and intervention. Clinicians should maintain a high index of suspicion for atypical presentations of preeclampsia to mitigate adverse maternal and fetal outcomes.