Differential Diagnosis for Distended Abdomen with Firm and Contracted Uterus Post CS

• Single Most Likely Diagnosis
  • Uterine atony with hemorrhage: This is a common cause of a distended abdomen and firm uterus post-cesarean section (CS), as uterine atony can lead to significant bleeding and subsequent abdominal distension.
• Other Likely Diagnoses
  • Postpartum hemorrhage (PPH) due to retained placental tissue: Retained placental tissue can cause bleeding and a firm, contracted uterus, leading to abdominal distension.
  • Infection (endometritis): Postpartum infection can cause uterine tenderness, fever, and abdominal distension, although the uterus may be more tender than firm.
  • Ovarian vein thrombosis: This is a less common but possible cause of postpartum abdominal pain and distension, often associated with a firm, tender mass.
• Do Not Miss Diagnoses
  • Uterine rupture: Although rare, uterine rupture is a life-threatening emergency that can present with abdominal distension and a firm uterus, especially if the rupture is contained.
  • Broad ligament hematoma: A broad ligament hematoma can cause significant bleeding and abdominal distension, and may be associated with a firm uterus if the hematoma is large enough to put pressure on the uterus.
  • Septic pelvic thrombophlebitis: This is a rare but potentially life-threatening condition that can cause abdominal pain, distension, and fever, and may be associated with a firm uterus.
• Rare Diagnoses
  • Uterine inversion: This is a rare complication of delivery that can cause abdominal distension and a firm uterus, although it is often associated with more dramatic symptoms such as severe hemorrhage and shock.
  • Abdominal compartment syndrome: This is a rare but potentially life-threatening condition that can cause abdominal distension, firmness, and organ dysfunction due to increased intra-abdominal pressure.