Differential Diagnosis for Abrupt Onset Shortness of Breath Two Days After Cesarean Delivery

• Single Most Likely Diagnosis
  • Pulmonary Embolism (PE): This is a leading cause of maternal mortality postpartum. The risk is increased due to the hypercoagulable state of pregnancy, immobility during and after surgery, and potential for venous thromboembolism. The abrupt onset of shortness of breath is a classic symptom.
• Other Likely Diagnoses
  • Postoperative Pneumonia: Infection can occur after any surgery, and the risk may be higher in patients undergoing cesarean delivery due to longer operative times and potential for respiratory compromise.
  • Respiratory Complications from Anesthesia: Although less common, complications from anesthesia such as aspiration pneumonia or respiratory depression can cause shortness of breath.
  • Postoperative Atelectasis: Shallow breathing and immobility post-surgery can lead to collapse of lung tissue, causing shortness of breath.
• Do Not Miss Diagnoses
  • Amniotic Fluid Embolism (AFE): Although rare, AFE is a catastrophic condition that can present with sudden onset of shortness of breath, hypotension, and potentially cardiac arrest. It's crucial to consider this diagnosis due to its high mortality rate.
  • Cardiac Complications (e.g., Myocardial Infarction, Cardiomyopathy): Pregnancy increases the risk of cardiac events, and symptoms can be atypical. Shortness of breath could be a presenting symptom of a cardiac issue.
  • Sepsis: Postpartum sepsis can present with respiratory symptoms among others, and it requires prompt recognition and treatment.
• Rare Diagnoses
  • Pulmonary Edema: Can occur due to fluid overload, pre-eclampsia, or cardiomyopathy. While not as common as other causes, it's an important consideration in the postpartum period.
  • Acute Respiratory Distress Syndrome (ARDS): A severe condition that can result from various causes, including sepsis, trauma, or direct lung injury. It's rare but critical to identify due to its high mortality rate.
  • Spontaneous Pneumothorax: Although rare, it can occur, especially in patients with underlying lung disease or those who have experienced barotrauma during mechanical ventilation.