Differential Diagnosis for 30 Week Pregnant Patient with Sudden Onset of Profuse Painless Fragile Bleeding
Single Most Likely Diagnosis
- Placenta Previa: This condition is characterized by the placenta partially or completely covering the internal cervical os, leading to painless vaginal bleeding in the second or third trimester. The sudden onset of profuse bleeding without pain is highly suggestive of placenta previa, especially in the absence of other symptoms like abdominal pain or uterine tenderness.
Other Likely Diagnoses
- Placental Abruption: Although typically associated with painful vaginal bleeding, a placental abruption can occasionally present with painless bleeding, especially if the abruption is marginal or the patient has a high pain threshold. The presence of risk factors such as hypertension or trauma increases the likelihood of this diagnosis.
- Uterine Rupture: While more commonly associated with severe abdominal pain, a uterine rupture can present with sudden onset of bleeding, especially in a patient with a previous uterine scar. However, the absence of pain makes this diagnosis less likely.
Do Not Miss Diagnoses
- Vasa Previa: This rare condition involves fetal blood vessels running through the membranes over the internal cervical os, unprotected by Wharton's jelly. Rupture of these vessels can lead to rapid fetal exsanguination and death. The key to diagnosing vasa previa is recognizing the risk factors, such as a velamentous cord insertion or a history of uterine surgery.
- Uterine Atony: Postpartum hemorrhage due to uterine atony can occur even in the preterm period, especially after a uterine rupture or placental abruption. Prompt recognition and management are crucial to prevent severe maternal morbidity.
Rare Diagnoses
- Choriocarcinoma: A rare malignant tumor that can cause vaginal bleeding during pregnancy. However, it is typically associated with other symptoms like abnormal uterine size, theca-lutein cysts, or metastatic disease.
- Uterine Artery Aneurysm Rupture: An extremely rare condition that can cause sudden, severe vaginal bleeding. It is often associated with underlying vascular disease or previous uterine surgery.