Differential Diagnosis for a 27-year-old Pregnant Female with Hematuria and Painful Urination

Single Most Likely Diagnosis

• Urinary Tract Infection (UTI): Given the symptoms of blood in the urine (hematuria) and pain while urinating (dysuria) in a pregnant woman, a UTI is a common and likely diagnosis. Pregnancy increases the risk of UTIs due to physiological changes that can predispose women to infection.

Other Likely Diagnoses

• Kidney Stones: Although the pain described is mild and intermittent, kidney stones (nephrolithiasis) can cause severe pain, hematuria, and are a consideration in anyone presenting with these symptoms. Pregnancy can increase the risk of stone formation due to increased urine calcium excretion and other factors.
• Pregnancy-related Hematuria: Hematuria can sometimes be seen in pregnancy due to the physiological changes and increased pressure on the urinary tract. However, this would typically not be associated with significant pain.

Do Not Miss Diagnoses

• Placenta Previa: Although less likely to present with dysuria, any vaginal bleeding or hematuria in pregnancy warrants consideration of placenta previa, especially if the patient reports any vaginal bleeding or if the hematuria is significant. This condition can be life-threatening if not promptly diagnosed and managed.
• Ectopic Pregnancy: While the patient reports being 10 weeks pregnant, ectopic pregnancy should always be considered in the differential diagnosis of any pregnant woman presenting with abdominal pain or bleeding, as it is a potentially life-threatening condition.
• Sepsis: If the patient's condition were to deteriorate or if she developed signs of infection such as fever, chills, or vomiting, sepsis would be a critical diagnosis not to miss, especially in the context of a possible UTI or other infection.

Rare Diagnoses

• Tumor or Cancer: Although rare, any unexplained hematuria could potentially be a sign of a urinary tract tumor or cancer. This would be less likely in a young pregnant woman but should be considered if other diagnoses are ruled out and hematuria persists.
• Glomerulonephritis or Other Renal Diseases: These conditions can cause hematuria and are important to consider, especially if the patient has a history of renal disease or if the hematuria is persistent and not explained by other diagnoses.