Differential Diagnosis for Syncope in a Pregnant Woman
- Single Most Likely Diagnosis
- Vasovagal Syncope: This is the most common cause of syncope in pregnant women, often triggered by emotional stress, pain, or prolonged standing. The physiological changes of pregnancy, such as increased blood volume and venous distensibility, can exacerbate the vasovagal response.
- Other Likely Diagnoses
- Orthostatic Hypotension: Due to the physiological changes of pregnancy, including venous pooling and decreased vascular tone, orthostatic hypotension is a common cause of syncope in pregnant women.
- Supine Hypotension Syndrome: Occurs when the pregnant uterus compresses the inferior vena cava, leading to decreased venous return and subsequent hypotension.
- Anemia: Common in pregnancy due to increased blood volume and demands for iron, anemia can lead to decreased oxygen delivery to tissues, potentially causing syncope.
- Do Not Miss Diagnoses
- Pulmonary Embolism: Although less common, pulmonary embolism is a life-threatening condition that can cause syncope. Pregnancy increases the risk of thromboembolism due to hypercoagulability and venous stasis.
- Cardiac Conditions (e.g., Arrhythmias, Cardiomyopathy): Pre-existing or pregnancy-induced cardiac conditions can lead to syncope and have significant implications for both mother and fetus.
- Preeclampsia: A condition characterized by hypertension and proteinuria, preeclampsia can lead to severe complications, including eclampsia and stroke, and may present with syncope.
- Rare Diagnoses
- Aortic Dissection: Although rare, aortic dissection is a life-threatening condition that can cause syncope. Pregnancy increases the risk due to hormonal changes that affect the aortic wall.
- Phaeochromocytoma: A rare tumor that can cause episodic hypertension and syncope, phaeochromocytoma requires prompt diagnosis and treatment to prevent severe complications.
- Neurocardiogenic Syncope due to Autonomic Dysfunction: Rare conditions affecting the autonomic nervous system, such as autonomic dysfunction, can lead to neurocardiogenic syncope.