A 37-year-old primigravida at 24 + 0/7 gestational weeks was involved a single-car accident at a speed of approximately 50 km/h. She was traveling in the left front passenger seat, had worn a three-point seatbelt restraint, and had the supplemental restraints and airbag system deployed. She was transported to our hospital by ambulance 1 h after the event. On examination, her vital signs were as follows: Glasgow Coma Scale, E4V5M6; blood pressure level, 90/50 mmHg; and heart rate, 90 beats/min. She suffered seatbelt injuries to her right thorax and entire lower abdomen and presented such severe pain to her lower abdomen that she was unable to move her body. Fetal heart rate monitoring indicated bradycardia of 80-90 beats/min with loss of variability that led to rapid demise. Whole-body computed tomography revealed intraperitoneal bleeding due to vessel injury around the uterus and placental lacerations over the seatbelt-compressed region (Figure 1). Blood tests revealed D-dimer coagulopathy of 31.7 microg/mL (normal level, <1 microg/mL) and fibrinogen degradation product of 58.0 microg/mL (normal level, <10 microg/mL). Rapid and massive blood transfusion therapy, insertion of an intra-aortic balloon occlusion catheter, and emergency laparotomy under the stabilization of maternal hemodynamics were immediately performed. Bleeding occurred all across the uterine surface during the operation (Figure 2). After delivery of a deceased male baby weighing 640 g via uterine incision, the extensive bleeding surrounding the uterine vessels was stopped using sutures. The total intraoperative hemorrhage was 2500 mL, and total 12 units of red blood cells, 12 units of fresh frozen plasma, and 20 units of platelets were transfused. The mother was admitted to the intensive care unit and discharged after 2 weeks of hospitalization. The placenta was macroscopically lacerated into several parts (Figure 3), and ischemic changes were microscopically noted. Written informed consent was obtained from the patient prior to publication of this case report and the accompanying images.