Differential Diagnosis for Vaginal Bleeding After Childbirth

• Single most likely diagnosis:
  • Postpartum hemorrhage (PPH) - This is the most common cause of vaginal bleeding after childbirth, often due to uterine atony, retained placental tissue, or lacerations.
• Other Likely diagnoses:
  • Retained products of conception - Bleeding can occur if parts of the placenta or fetus are not fully expelled during delivery.
  • Uterine inversion - A condition where the uterus turns inside out, which can cause severe bleeding.
  • Lacerations or episiotomy complications - Tears or cuts in the vaginal or perineal area can bleed significantly.
  • Infection - Endometritis or other infections can cause bleeding, especially if there are retained products of conception or foreign bodies.
• Do Not Miss diagnoses:
  • Amniotic fluid embolism - Although rare, this condition can cause sudden onset of bleeding, hypotension, and respiratory distress.
  • Uterine rupture - A life-threatening condition that requires immediate surgical intervention.
  • Coagulopathy - Bleeding disorders such as disseminated intravascular coagulation (DIC) can lead to severe bleeding.
  • Placenta accreta spectrum (PAS) disorders - Abnormal placental attachment can cause severe bleeding during or after delivery.
• Rare diagnoses:
  • Uterine artery pseudoaneurysm - A rare condition where a blood vessel in the uterus forms a false aneurysm, leading to delayed postpartum hemorrhage.
  • Choriocarcinoma - A rare type of cancer that can cause vaginal bleeding after pregnancy.
  • Arteriovenous malformation - Abnormal connections between arteries and veins can cause bleeding, although this is extremely rare in the postpartum setting.