Differential Diagnosis for Severe Bleeding in a 25-Week Pregnant Patient
The patient's history of hernioplasty and current pregnancy complications suggest several possible causes for the severe bleeding. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Placental abruption: This condition, where the placenta separates from the uterus, is a common cause of severe bleeding in pregnancy, especially in the second and third trimesters. The patient's symptoms of severe bleeding and the presence of a normal fetal heart sound prior to the event support this diagnosis.
- Other Likely diagnoses
- Placenta previa: Although less likely than placental abruption, placenta previa, where the placenta covers the cervix, can cause severe bleeding in pregnancy. The patient's history of previous uneventful pregnancies and the sudden onset of bleeding make this a possible diagnosis.
- Uterine rupture: Given the patient's history of hernioplasty, which may indicate a previous abdominal surgery, there is a possibility of uterine rupture, especially if the previous surgery involved the uterus.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Uterine dehiscence: Similar to uterine rupture, uterine dehiscence, where there is a partial separation of the uterine scar, can cause severe bleeding and is a life-threatening condition.
- Amniotic fluid embolism: Although rare, amniotic fluid embolism is a deadly condition that can cause severe bleeding, hypotension, and respiratory distress.
- Rare diagnoses
- Vasa previa: This rare condition, where fetal blood vessels are present in the membranes covering the cervix, can cause severe bleeding when the membranes rupture.
- Uterine artery rupture: This rare condition can cause severe bleeding and is often associated with previous uterine surgery or trauma.