Clinical Diagnosis :

Placental abruption is mainly a clinical diagnosis based on findings of vaginal bleeding, abdominal pain, uterine tenderness, uterine contractions, and fetal distress.

Classification of placental abruption is based on extent of separation (ie, partial vs complete) and location of separation (ie, marginal vs central). Clinical characteristics include the following:

• Class 0: asymptomatic. Diagnosis is made retrospectively by finding an organized blood clot or a depressed area on a delivered placenta.

• Class 1: mild and represents approximately 48% of all cases. Characteristics include the following:
  No vaginal bleeding to mild vaginal bleeding
  Slightly tender uterus
  Normal maternal BP and heart rate
  No coagulopathy
  No fetal distress
  

• Class 2: moderate and represents approximately 27% of all cases. Characteristics include the following:
  No vaginal bleeding to moderate vaginal bleeding
  Moderate-to-severe uterine tenderness with possible tetanic contractions
  Maternal tachycardia with orthostatic changes in BP and heart rate
  Fetal distress
  Hypofibrinogenemia (ie, 50-250 mg/dL)
  

• Class 3: severe and represents approximately 24% of all cases. Characteristics include the following:
  No vaginal bleeding to heavy vaginal bleeding
  Very painful tetanic uterus
  Maternal shock
  Hypofibrinogenemia (ie, <150 mg/dL)
  Coagulopathy
  Fetal death