Differential Diagnosis
- Single most likely diagnosis
- Placental abruption: The patient's symptoms of abdominal pain, nausea, vomiting, and uterine contractions, along with the presence of a firm, tender mass and fundal tenderness, are consistent with placental abruption. The elevated leukocyte count may also indicate an inflammatory response to the abruption.
- Other Likely diagnoses
- Preterm labor: The patient's uterine contractions and cervical status suggest preterm labor, which could be precipitated by an underlying condition such as placental abruption or infection.
- Uterine torsion: Although less common, uterine torsion can cause severe abdominal pain and vomiting, especially in the presence of a uterine mass or anomaly.
- Ovarian torsion: The patient's right-sided abdominal pain and vomiting could be consistent with ovarian torsion, although this is less likely given the presence of uterine contractions and fundal tenderness.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Uterine rupture: Although the patient's history of cesarean delivery increases her risk, the absence of vaginal bleeding or leakage of fluid makes this diagnosis less likely. However, uterine rupture is a life-threatening emergency that requires prompt recognition and intervention.
- Eclampsia: The patient's symptoms of abdominal pain, nausea, and vomiting, along with her elevated blood pressure, could be consistent with eclampsia. However, the absence of seizures or proteinuria makes this diagnosis less likely.
- Rare diagnoses
- Hepatic rupture: This rare condition can cause severe abdominal pain and vomiting, especially in pregnant women with underlying liver disease or preeclampsia.
- Appendicitis: Although appendicitis is less common during pregnancy, it can still occur and may present with atypical symptoms, such as right upper quadrant pain or vomiting.