Differential Diagnosis for Suspected PPROM and APH in the Setting of Retrochorial Hematoma/Abruptio Placenta
- Single Most Likely Diagnosis
- Placental abruption: This is the most likely diagnosis given the presence of a retrochorial hematoma, which is a collection of blood between the placenta and the uterus, indicative of placental separation. The symptoms of abdominal pain and vaginal bleeding (APH) are classic for placental abruption.
- Other Likely Diagnoses
- Preterm premature rupture of membranes (PPROM): The initial suspicion of PPROM could still be valid, especially if there are signs of membrane rupture such as a gush of fluid or a positive nitrazine test. PPROM can coexist with placental abruption.
- Uterine rupture: Although less common, uterine rupture could present with similar symptoms, especially in a patient with a previous uterine scar. The presence of a retrochorial hematoma might increase the risk of uterine rupture due to the weakening of the uterine wall.
- Do Not Miss Diagnoses
- Placenta accreta spectrum (PAS) disorders: These conditions, including placenta accreta, increta, and percreta, involve abnormal placental attachment and can lead to severe bleeding and other complications. They might not be the first consideration but are critical to diagnose due to their potential for severe morbidity and mortality.
- Uterine dehiscence: Similar to uterine rupture, dehiscence (a partial tear) could present with abdominal pain and might be associated with a retrochorial hematoma. It's less severe than rupture but still requires prompt attention.
- Rare Diagnoses
- Vasa previa: This condition involves fetal blood vessels crossing the internal cervical os, unprotected by Wharton's jelly, and can cause severe fetal bleeding if ruptured. It's rare but could present with vaginal bleeding and is critical to diagnose due to its high risk of fetal morbidity and mortality.
- Choriocarcinoma: A rare malignant tumor that could cause abnormal uterine bleeding and might be associated with a retrochorial hematoma, although this would be an uncommon presentation.