Differential Diagnosis
- Single most likely diagnosis
- Uterine inversion: This is the most likely cause of the patient's symptoms, given the history of precipitous delivery, prolonged umbilical cord traction, and the sudden onset of severe abdominal pain and hypotension after the umbilical cord avulsed. The presence of a firm, rounded mass protruding from the vagina, which is likely the inverted uterus, further supports this diagnosis.
- Other Likely diagnoses
- Uterine atony with severe postpartum hemorrhage: Although the presence of a firm, rounded mass protruding from the vagina suggests uterine inversion, uterine atony with severe postpartum hemorrhage could also present with similar symptoms, including severe abdominal pain, hypotension, and copious vaginal bleeding.
- Retained placental tissue: The patient's symptoms could also be caused by retained placental tissue, which can lead to severe postpartum hemorrhage and uterine inversion. However, the presence of a firm, rounded mass protruding from the vagina makes this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Amniotic fluid embolism: Although this diagnosis is less likely given the patient's symptoms, it is a potentially life-threatening condition that should not be missed. Amniotic fluid embolism can present with sudden onset of hypotension, hypoxia, and cardiac arrest.
- Uterine rupture: This is another potentially life-threatening condition that should not be missed. Uterine rupture can present with severe abdominal pain, hypotension, and vaginal bleeding, although it is less likely given the patient's symptoms and the presence of a firm, rounded mass protruding from the vagina.
- Rare diagnoses
- Placenta accreta spectrum disorders: These disorders, which include placenta accreta, placenta increta, and placenta percreta, are rare but can cause severe postpartum hemorrhage and uterine inversion. However, they are less likely given the patient's symptoms and the presence of a firm, rounded mass protruding from the vagina.
- Uterine dehiscence: This is a rare condition where there is a partial separation of the uterine muscle, which can cause severe abdominal pain, hypotension, and vaginal bleeding. However, it is less likely given the patient's symptoms and the presence of a firm, rounded mass protruding from the vagina.