Background: Couvelaire uterus, also known as uteroplacental apoplexy, is a rare but nonfatal condition resulting from extravasation of blood into the uterine musculature and surrounding tissues. Objective: presentation of a case of huge intramyometrial hematoma (Couvelaire uterus) developed postpartum in a preserved uterus in a case of placenta previa accreta, which is atypical presentation in such cases. Case Report: 29 years old female patient 38 weeks pregnancy. Pregnancy was terminated by CS due to placenta previa cenralis accreta. During CS, preservation of the uterus was done by application of multiple haphazard haemostatic sutures and bilateral uterine artery ligation. The patient presented by post-partum collapse. Ultrasonographic examination revealed huge intramyometrial hematoma (Cauvlair uterus). Exploration was done with confirmation of the ultrasonographic picture. Subtotal abdominal hysterectomy was done with preservation of both ovaries with uneventful post portative period. Examination revealed huge intramyometrial hematoma (Cauvlair uterus). Conclusion: Post-partum intramyometrial hematoma (Couvelaire uterus) is atypical presentation in cases of preserved uterus in patients with placenta accreta and it may result from multiple haphazard unorganized haemostatic sutures. Therefore, the obstetricians should be aware of such rare complication for early diagnosis and management.