Differential Diagnosis for 37 Week Pregnant Patient

The patient's symptoms of shortness of breath (SOB), headache, blurry vision, extremity swelling, and lower abdominal pain at 37 weeks of gestation can be attributed to several conditions. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Preeclampsia: This condition is characterized by the onset of hypertension and often proteinuria after 20 weeks of gestation. The symptoms presented, such as headache, blurry vision, and extremity swelling, are classic for preeclampsia. The lower abdominal pain could be related to the liver capsule distension seen in severe preeclampsia (HELLP syndrome).

• Other Likely Diagnoses

  • Gestational Hypertension: Similar to preeclampsia but without proteinuria. It can still cause headaches and vision changes due to hypertension.
  • Chronic Hypertension with Superimposed Preeclampsia: If the patient had pre-existing hypertension, the superimposition of preeclampsia could explain the worsening symptoms.
  • Placental Abruption: Although more commonly associated with vaginal bleeding and abdominal pain, placental abruption can cause maternal hypertension and, in severe cases, symptoms overlapping with preeclampsia.

• Do Not Miss Diagnoses

  • Pulmonary Embolism (PE): A life-threatening condition that can cause SOB and, in rare cases, can be associated with headache and vision changes due to hypoxia. Pregnancy increases the risk of PE.
  • Stroke or Transient Ischemic Attack (TIA): Headache and blurry vision could be symptoms of a stroke or TIA, especially in the context of hypertension.
  • Cardiac Conditions (e.g., Peripartum Cardiomyopathy): Can cause SOB, lower abdominal pain (due to an enlarged heart pressing on the diaphragm), and potentially other symptoms if there's associated hypertension or arrhythmia.

• Rare Diagnoses

  • Posterior Reversible Encephalopathy Syndrome (PRES): A rare condition associated with preeclampsia, characterized by headache, vision changes, and seizures, due to cerebral vasculature changes.
  • Thrombotic Thrombocytopenic Purpura (TTP) or Hemolytic Uremic Syndrome (HUS): Rare conditions that can cause a variety of symptoms including headache, vision changes, and abdominal pain, but are more commonly associated with thrombocytopenia, microangiopathic hemolytic anemia, and renal failure.
  • Acute Fatty Liver of Pregnancy: A rare but serious condition that can cause abdominal pain, hypertension, and in severe cases, symptoms that overlap with preeclampsia or HELLP syndrome.