Differential Diagnosis for Post D&C Abdominal Pain, Guarding, and Bleeding

• Single Most Likely Diagnosis
  • Infection (endometritis): This is a common complication following a D&C procedure, especially if the patient has a history of pelvic inflammatory disease or if the procedure was not performed under sterile conditions. Symptoms such as abdominal pain, guarding, and bleeding, along with fever and malaise, support this diagnosis.
• Other Likely Diagnoses
  • Retained products of conception: This condition occurs when parts of the placenta or fetus are not completely removed during the D&C, leading to infection, bleeding, and abdominal pain.
  • Uterine perforation: Although less common, uterine perforation during a D&C can cause abdominal pain, guarding, and bleeding due to potential injury to surrounding organs.
  • Asherman's syndrome: This condition, characterized by the formation of adhesions in the uterus, can lead to abdominal pain and bleeding, but it typically presents later after the procedure.
• Do Not Miss Diagnoses
  • Hemorrhage: Severe bleeding can be life-threatening and requires immediate attention. It may be due to uterine atony, retained products of conception, or vascular injury.
  • Uterine rupture: Although rare, uterine rupture is a life-threatening emergency that can occur during or after a D&C, especially in patients with a previous uterine scar.
  • Broad ligament hematoma: This is a rare but potentially life-threatening condition where bleeding occurs into the broad ligament, causing abdominal pain and potentially leading to shock.
• Rare Diagnoses
  • Amniotic fluid embolism: This is a rare but potentially fatal condition where amniotic fluid enters the maternal circulation, causing a severe reaction.
  • Coagulopathy: Certain conditions that affect blood clotting can lead to excessive bleeding after a D&C, although these are less common and often have other associated symptoms or risk factors.