What are the key clinical signs and symptoms that indicate a diagnosis of placental abruption?

Key clinical signs and symptoms indicating a diagnosis of placental abruption include sudden onset of abdominal pain, vaginal bleeding, uterine tenderness, and increased uterine tone or rigidity. The bleeding may be visible or concealed behind the placenta, leading to variable amounts of vaginal blood loss. Women often report a painful, tense uterus with frequent contractions and sometimes fetal distress or reduced fetal movements. Additionally, signs of maternal shock such as tachycardia and hypotension may be present in severe cases. These features reflect the premature separation of the placenta from the uterine wall, causing bleeding and uterine irritation NICE NG25 Hladky et al. 2002Brandt & Ananth 2023Schneider & Kinzler 2025.

Specifically, the classic triad comprises vaginal bleeding, abdominal pain, and uterine tenderness, but the presentation can vary depending on the extent and location of the abruption. Concealed hemorrhage may present predominantly with pain and uterine signs without obvious bleeding. Fetal compromise signs such as abnormal cardiotocography or reduced movements are important clinical indicators supporting the diagnosis NICE NG25 Brandt & Ananth 2023Schneider & Kinzler 2025.