Differential Diagnosis for Postpartum Pelvic Pain
Single Most Likely Diagnosis
- Ovarian cyst or torsion: Although the pelvic ultrasound is normal, it's possible that a small cyst or torsion was missed, or it could have developed after the ultrasound. Ovarian cysts are common in women of reproductive age, and torsion can cause severe pelvic pain.
Other Likely Diagnoses
- Constipation or bowel obstruction: Postpartum women are at risk for constipation due to hormonal changes, pain medications, and decreased mobility. Constipation can cause significant abdominal pain, especially if it leads to a bowel obstruction.
- Urinary tract infection (UTI) or pyelonephritis: Although the labs are normal, a UTI or pyelonephritis can cause severe pelvic pain, and the infection may not be evident on initial lab tests.
- Endometritis: Infection of the uterus can cause pelvic pain, fever, and abnormal vaginal discharge. It's a possible complication of childbirth, especially if there were any issues during delivery.
Do Not Miss Diagnoses
- Ectopic pregnancy: Although the patient is 5 weeks postpartum, it's possible that she could have a heterotopic pregnancy (a rare condition where a woman has both an intrauterine and an ectopic pregnancy). Ectopic pregnancy is a life-threatening condition that requires immediate attention.
- Appendicitis: Appendicitis can cause severe right lower quadrant pain and is a surgical emergency. It's essential to consider this diagnosis, even if the labs and ultrasound are normal.
- Pulmonary embolism: Postpartum women are at increased risk for pulmonary embolism due to hypercoagulability. Although the pain is localized to the pelvic area, it's possible that the patient could have a pulmonary embolism that's causing referred pain.
Rare Diagnoses
- Adnexal tumor: A rare tumor of the ovary or fallopian tube could cause pelvic pain.
- Inflammatory bowel disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause chronic pelvic pain and may be exacerbated by pregnancy and childbirth.
- Pelvic vein thrombosis: A rare condition where a blood clot forms in the pelvic veins, causing pain and swelling.