Differential Diagnosis for Hip Flexor Cramping and Intermittent Walking Difficulty at 37 Weeks Pregnancy

• Single most likely diagnosis:
  • Braxton Hicks contractions: These are practice contractions that can feel like menstrual cramps or a tightening sensation in the abdomen, and sometimes radiate to the hips or lower back. They are common in the third trimester and can cause discomfort, but they are usually not as intense as real labor contractions.
• Other Likely diagnoses:
  • Round ligament pain: As the uterus expands, the round ligaments that support it can stretch and cause sharp pains or cramping in the hips, abdomen, or groin.
  • False labor (prodromal labor): This is a condition where women experience contractions that can be uncomfortable and may feel like real labor, but they do not lead to cervical dilation or the progression of labor.
  • Hip flexor strain: The hip flexor muscles can become strained due to the weight and pressure of the growing uterus, leading to cramping and discomfort.
• Do Not Miss diagnoses:
  • Preterm labor: Although the patient is at 37 weeks, which is considered term, it's essential to rule out preterm labor, especially if the contractions are regular, intense, and accompanied by other symptoms like vaginal bleeding or a sudden gush of fluid.
  • Placental abruption: This is a life-threatening condition where the placenta separates from the uterus, causing severe abdominal pain, vaginal bleeding, and potentially compromising the baby's oxygen supply.
  • Uterine rupture: Although rare, uterine rupture can occur, especially in women with a history of uterine surgery or previous cesarean delivery. It can cause severe abdominal pain, contractions, and potentially life-threatening complications.
• Rare diagnoses:
  • Osteonecrosis of the hip: This is a rare condition where the blood supply to the hip joint is disrupted, leading to pain and limited mobility.
  • Piriformis syndrome: This is a condition where the piriformis muscle in the buttocks compresses the sciatic nerve, causing pain, numbness, and tingling in the hips and legs.