Differential Diagnoses for Pregnancy
The following differential diagnoses are organized into categories to guide the diagnostic process for a pregnant patient.
- Single Most Likely Diagnosis
- Normal Pregnancy: This is the most likely diagnosis if the patient presents with a positive pregnancy test, typical symptoms of pregnancy (e.g., morning sickness, fatigue), and a normal physical exam. Justification: The majority of pregnancies are normal, and most symptoms can be attributed to the normal physiological changes of pregnancy.
- Other Likely Diagnoses
- Ectopic Pregnancy: Considered in patients with abdominal pain, vaginal bleeding, and a positive pregnancy test. Justification: Ectopic pregnancy is a common cause of first-trimester bleeding and abdominal pain.
- Miscarriage: Diagnosed in patients with vaginal bleeding, cramping, and a history of missed periods. Justification: Miscarriage is a common complication of early pregnancy.
- Molar Pregnancy: Suspected in patients with excessive uterine size, severe morning sickness, and a positive pregnancy test. Justification: Molar pregnancy is a rare but potentially life-threatening condition.
- Do Not Miss Diagnoses
- Pulmonary Embolism: Considered in patients with sudden onset of shortness of breath, chest pain, and risk factors for thromboembolism. Justification: Pulmonary embolism is a life-threatening condition that can occur during pregnancy due to increased coagulability.
- Placenta Previa: Diagnosed in patients with painless vaginal bleeding and a history of placental abnormalities. Justification: Placenta previa can cause severe bleeding and is a life-threatening condition if not promptly diagnosed and treated.
- Preeclampsia: Suspected in patients with new-onset hypertension, proteinuria, and symptoms such as headache and visual disturbances. Justification: Preeclampsia is a life-threatening condition that can cause maternal and fetal morbidity if not promptly diagnosed and treated.
- Rare Diagnoses
- Gestational Trophoblastic Disease: Considered in patients with excessive uterine size, severe morning sickness, and a positive pregnancy test. Justification: Gestational trophoblastic disease is a rare but potentially life-threatening condition.
- Ovarian Torsion: Diagnosed in patients with sudden onset of severe abdominal pain and a history of ovarian cysts. Justification: Ovarian torsion is a rare but life-threatening condition that requires prompt surgical intervention.
Tests to Run
The following tests should be considered based on the differential diagnoses:
- Pregnancy test (urine or serum)
- Ultrasound (transvaginal or transabdominal)
- Complete blood count (CBC)
- Blood type and Rh factor
- Coagulation studies (e.g., PT, aPTT)
- Liver function tests (e.g., ALT, AST)
- Renal function tests (e.g., creatinine, urea)
- Urinalysis
- Electrocardiogram (ECG)
- Chest X-ray (if suspected pulmonary embolism)
- D-dimer (if suspected pulmonary embolism)