Differential Diagnosis for Fetal Breech Presentation
- Single most likely diagnosis
- Uterine leiomyomas (fibroids): The patient's history of multiple intramural and submucosal leiomyomas is the most likely cause of the fetal breech presentation. The presence of these fibroids can interfere with the normal engagement of the fetal head into the pelvis, leading to a breech presentation.
- Other Likely diagnoses
- Placenta location: The fundal placenta may contribute to the breech presentation, as it can occupy space in the lower uterine segment and prevent the fetal head from engaging in the pelvis.
- Fetal size and gestational age: The estimated fetal weight at the 80th percentile for gestational age may also contribute to the breech presentation, as larger fetuses are more likely to present in a breech position.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Uterine anomaly: Although not directly mentioned in the patient's history, a uterine anomaly such as a unicornuate or bicornuate uterus could increase the risk of breech presentation and should be considered to rule out any potential complications.
- Placenta accreta spectrum (PAS) disorders: Although the patient has no history of vaginal bleeding, the presence of a fundal placenta and uterine leiomyomas may increase the risk of PAS disorders, which can be life-threatening if not diagnosed and managed properly.
- Rare diagnoses
- Fetal neuromuscular disorders: Rare conditions such as fetal neuromuscular disorders (e.g., myotonic dystrophy) can increase the risk of breech presentation, although there is no indication of such a condition in the patient's history.
- Amniotic fluid abnormalities: Although the amniotic fluid index is within normal limits, rare conditions such as amniotic fluid embolism or chorioamnionitis could potentially contribute to breech presentation, although these conditions are unlikely given the patient's presentation and normal vital signs.