Placental abruption is a potentially life-threatening obstetric complication, often associated with hypertensive disorders of pregnancy. While its occurrence in the context of preeclampsia is well-documented, it is uncommon for placental abruption to serve as the initial clinical manifestation. We report the case of a 23-year-old primigravida at 30 weeks of gestation who presented with abruptio placentae and was subsequently diagnosed with severe preeclampsia. Intraoperative findings revealed a Couvelaire uterus, a rare consequence of placental abruption characterized by extravasation of blood into the myometrium. Prompt cesarean delivery and conservative management resulted in favorable maternal and neonatal outcomes. This case underscores the importance of recognizing atypical presentations of hypertensive disorders during pregnancy and the critical role of timely intervention.