Differential Diagnosis for Benign Causes of PVB Bleed in 35+1 Weeks Pregnancy
Single Most Likely Diagnosis
- Placental Abruption: This condition is a common cause of vaginal bleeding in the third trimester, especially after 35 weeks of gestation. It occurs when the placenta partially or completely separates from the uterus, leading to bleeding and potentially compromising fetal well-being.
Other Likely Diagnoses
- Placenta Previa: Although less common than placental abruption, placenta previa can cause painless vaginal bleeding in the late third trimester. It is characterized by the placenta covering or being proximate to the internal cervical os.
- Vaginal or Cervical Lesions: Benign lesions such as polyps, varices, or cervical ectropion can cause bleeding, especially if they are irritated or if there is an increase in blood volume and pressure during pregnancy.
- Sexual Intercourse: Trauma from sexual intercourse can lead to bleeding, especially if there are any pre-existing cervical or vaginal lesions.
Do Not Miss Diagnoses
- Uterine Rupture: Although rare, uterine rupture is a life-threatening condition that can present with vaginal bleeding, severe abdominal pain, and fetal distress. It is more common in women with a history of uterine surgery, including cesarean deliveries.
- Vasa Previa: This condition involves fetal blood vessels running through the membranes over the internal cervical os, which can rupture and cause severe fetal bleeding. It is critical to diagnose vasa previa to prevent significant fetal morbidity and mortality.
Rare Diagnoses
- Choriocarcinoma: A rare malignant tumor that can cause vaginal bleeding during pregnancy. It is often associated with abnormal uterine bleeding, but in pregnancy, it can present with metastatic disease.
- Uterine Arteriovenous Malformation (AVM): A rare vascular anomaly that can cause recurrent vaginal bleeding during pregnancy due to the risk of rupture of the AVM.