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Background and Aims Placental abruption is a serious obstetric complication characterized by the premature separation of the placenta from the uterus. It is relatively rare but places the well-being of mother and fetus at greater risk. While the clinical presentations can vary, pain during epidural labor analgesia is not typically associated with this condition and often associated with epidural failure.

Methods We report the case of a 21-year-old primigravida who experienced unusual severe pain during epidural analgesia for labor. Despite initial effective pain relief with epidural analgesia with levobupivacaine 0.125% and fentanyl 2mcg/ml, the patient reported sudden onset of severe localized pain with tetanic uterine contraction, which was initially attributed to epidural failure. However, further evaluation and examination along with the obstetric team revealed an underlying placental abruption. The patient was then underwent category 1 caesarean section under general anesthesia. The baby was born with APGAR score of 9. Intraoperative findings confirmed the diagnosis of placental abruption. Epidural top up was used for postoperative analgesia.

Results The patient remained hemodynamically stable during the operation. The mother and the newborn had favorable outcomes postdelivery. Patient was satisfied with epidural analgesia on follow up visit.

Conclusions The unusual presentation of pain during epidural analgesia prompted a timely diagnosis and intervention, highlighting the importance of vigilance for atypical signs of serious obstetric complications during labor epidural analgesia. This case underscores the need for anesthetist as well as other healthcare providers to evaluate for a cause that could be more serious when patients report atypical pain during epidural labor analgesia.