Background <p>Umbilical cord ulceration (UCU) is a rare but potentially fatal obstetric condition characterized by ulcerative disruption of the umbilical cord, often leading to fetal hemorrhage and intrauterine fetal demise. Placental abruption, defined as the premature separation of the placenta from the uterine wall, is another major cause of perinatal mortality. When UCU is complicated by occult placental abruption, the risk of adverse perinatal outcomes increases substantially. These associations highlight the importance of vigilant prenatal surveillance and comprehensive imaging to facilitate early detection and timely intervention.</p> Case presentation <p>We report a case involving a 33-year-old woman at 37 weeks and 5 days of gestation who presented with abdominal tightness and subjectively reduced fetal movements. Prenatal ultrasound and Color Doppler imaging (CDI) revealed umbilical cord abnormalities, including loss of Wharton’s jelly and absent blood flow signals. An emergency cesarean section was promptly performed, resulting in favorable maternal and neonatal outcome. Postoperative pathological examination confirmed the diagnosis of UCU with hemorrhage, complicated by placental abruption.</p> Conclusions <p>To our knowledge, this is the first reported case of UCU complicated by placental abruption. This case underscores the importance of considering UCU in the differential diagnosis of unexplained fetal distress in late pregnancy. Early recognition and timely intervention guided by prenatal imaging are essential for improving perinatal outcomes.</p>