Differential Diagnosis for Vaginal Bleeding at 26 Weeks Pregnancy

• Single most likely diagnosis
  • Placenta previa: This condition, where the placenta partially or completely covers the cervix, is a common cause of vaginal bleeding in the second and third trimesters. The bleeding is typically painless and can be triggered by sexual intercourse or a digital vaginal exam.
• Other Likely diagnoses
  • Cervical polyp or cervical lesion: Benign growths on the cervix can cause bleeding, especially after sexual intercourse or a pelvic exam.
  • Vaginal or cervical infection: Infections such as cervicitis or vaginitis can cause inflammation and bleeding.
  • Sexual intercourse: Vigorous sexual activity can cause minor trauma to the cervix or vagina, leading to bleeding.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Placental abruption: This is a life-threatening condition where the placenta separates from the uterus, causing bleeding and depriving the fetus of oxygen and nutrients. The bleeding can be concealed (hidden behind the placenta) or visible.
  • Uterine rupture: Although rare, uterine rupture can occur in women with a previous uterine scar (e.g., from a cesarean section) and can cause catastrophic bleeding and fetal distress.
• Rare diagnoses
  • Molar pregnancy with persistent trophoblastic disease: Although typically diagnosed earlier in pregnancy, a molar pregnancy can cause bleeding in the second trimester.
  • Uterine or cervical cancer: Although extremely rare, cancer can cause vaginal bleeding during pregnancy.
  • Vasa previa: This condition, where fetal blood vessels are present in the membranes covering the cervix, can cause bleeding when the vessels rupture.