Differential Diagnosis for Intrauterine Fetal Demise
The patient's presentation of decreased fetal movement and subsequent confirmation of intrauterine fetal demise (IUFD) at 24 weeks gestation, following a recent episode of gastrointestinal symptoms, suggests an infectious etiology. The differential diagnosis can be categorized as follows:
- Single most likely diagnosis
- Listeria monocytogenes: This bacterium is a well-known cause of IUFD, particularly in the second and third trimesters. The patient's recent history of nausea, watery diarrhea, and muscle aches, which resolved after 24 hours, is consistent with a gastrointestinal infection. Listeria can cause a mild, self-limiting illness in the mother, but it can lead to severe fetal consequences, including IUFD.
- Other Likely diagnoses
- Salmonella: Similar to Listeria, Salmonella can cause a gastrointestinal infection in the mother, which may be mild but can lead to severe fetal outcomes, including IUFD.
- E. coli: Certain strains of E. coli can cause urinary tract infections (UTIs) or gastrointestinal infections in pregnant women, potentially leading to IUFD.
- Parvovirus B19: Although typically associated with a milder disease, Parvovirus B19 can cause IUFD, especially if the infection occurs during the second trimester.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Placental abruption: Although the patient does not have vaginal bleeding or abdominal pain, placental abruption can cause IUFD and should be considered, especially if there are any changes in the patient's symptoms or examination.
- Uterine rupture: This is a rare but life-threatening condition that can cause IUFD. Although the patient has no history of uterine surgery or trauma, it should be considered in the differential diagnosis.
- Rare diagnoses
- Toxoplasmosis: Although Toxoplasmosis can cause IUFD, it is relatively rare and typically associated with other symptoms, such as flu-like illness or lymphadenopathy.
- Coxiella burnetii (Q fever): This bacterium can cause a mild illness in the mother but has been associated with IUFD, particularly in endemic areas. However, it is a rare cause of IUFD and would require specific epidemiological exposure.