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Ultrasound is often the first and usually the only imaging modality used to evaluate placental abruption, but an index of suspicion should be maintained for the diagnosis since ultrasound is relatively insensitive for the diagnosis. This is partly because a retroplacental hematoma may be identified only in 2-25% of all abruptions.
The echogenicity of hematomas depends upon their age. Acute hematomas imaged at the time of symptoms tend to be hyperechoic or isoechoic compared to the adjacent placenta. As the hematoma is commonly isoechoic to the placenta, it may be mistaken for focal thickening of the placenta.
Common locations are subchorionic (between the placenta and the membranes), retroplacental (between the placenta and the myometrium), and preplacental (between the placenta and the amniotic fluid). Retroplacental hematomas have a variable appearance; they can appear solid, complex, and hypo-, hyper-, or isoechoic compared with the placenta. If hypoechoic, then it is most probably resolving and therefore not acute. A retroplacental hematoma is more likely to be seen with more extensive placental separation and in patients who go on to have adverse maternal and perinatal outcome but its absence does not exclude the possibility of abruption, including a severe abruption, because blood may not collect and remain behind the placenta. Other findings suggestive of abruption include a subchorionic collection of fluid (even remote from the placental attachment site), echogenic debris in the amniotic fluid, or a thickened placenta; especially if it shimmers with maternal movement ("Jello" sign), placental thickening to over 5.5cm and separation of placental edges. However the main aspect to remember is that ultrasound may not always detect placental abruption so in an emergency it is best to manage based on clinical findings.
References for added info:
https://radiopaedia.org/articles/placental-abruption#:~:text=Placental%20abruption%20(or%20abruptio%20placentae,%2Dtrimester%20bleeding%2Fantepartum%20hemorrhage.
"Acute placental abruption: Pathophysiology, clinical features, diagnosis, and consequences" from Up To Date
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Shinde GR, Vaswani BP, Patange RP, et al. Diagnostic Performance of Ultrasonography for Detection of Abruption and Its Clinical Correlation and Maternal and Foetal Outcome. J Clin Diagn Res 2016; 10:QC04.
Qiu Y, Wu L, Xiao Y, Zhang X. Clinical analysis and classification of placental abruption. J Maternal Fetal Neonatal Med 2021; 34:2952
Yeo L, Ananth CV, Vintzileos AM. Placental abruption, Lippincott, Williams &Wilkins, Hagerstown, Maryland 2003.