Differential Diagnosis for M.R.
Single Most Likely Diagnosis
- Preterm Labor: The patient is experiencing bloody mucoid vaginal discharge, and upon physical examination, the cervix is found to be 8 cm dilated and 80% effaced, indicating preterm labor. The patient's history of gestational hypertension and gestational diabetes mellitus, as well as her poor obstetric history, increases her risk for preterm labor.
Other Likely Diagnoses
- Placenta Previa: The patient's complaint of bloody mucoid vaginal discharge could be indicative of placenta previa, especially given her history of gestational hypertension and gestational diabetes mellitus. However, the ultrasound performed at 19 1/7 weeks AOG showed a posterior placenta, grade 1, which makes this diagnosis less likely.
- Cervical Insufficiency: The patient's history of recurrent pregnancy losses and preterm births increases her risk for cervical insufficiency, which could be contributing to her current preterm labor.
- Intrauterine Infection: The patient's symptoms of bloody mucoid vaginal discharge could be indicative of an intrauterine infection, although there are no other symptoms such as fever or uterine tenderness.
Do Not Miss Diagnoses
- Placental Abruption: Although the patient's ultrasound showed a posterior placenta, grade 1, placental abruption is a life-threatening condition that must be considered in any patient presenting with vaginal bleeding. The patient's history of gestational hypertension increases her risk for placental abruption.
- Uterine Rupture: The patient's history of multiple pregnancies and poor obstetric history increases her risk for uterine rupture, which is a life-threatening condition.
Rare Diagnoses
- Vasa Previa: The patient's complaint of bloody mucoid vaginal discharge could be indicative of vasa previa, although this is a rare condition. The patient's ultrasound did not specifically mention the presence of vasa previa.
- Choriocarcinoma: The patient's history of gestational trophoblastic disease is not mentioned, but choriocarcinoma is a rare condition that could present with vaginal bleeding. However, this diagnosis is unlikely given the patient's presentation and history.