Purpose of investigation: The authors report a case of severe postpartum hemorrhage (PPH) with placental abruption managed using the uterine sandwich. Case Report: A 24-year-old woman with placental abruption was referred to Yamaguchi Grand Medical Center at 35 weeks of gestation. Cesarean section was performed, and severe PPH occurred. After an intrauterine Bakri balloon and B-Lynch suture were applied and uterine bleeding was controlled. The total blood loss was 4, 090 ml. Transfusion included 16, 22, and 20 U of red cell concentrates (RCC), fresh frozen plasma (FFP), and platelet concentrates (PC), respectively. The patient was discharged with no complications eight days postoperatively. Conclusion: The uterine sandwich is an effective option for the treatment of severe PPH.