Differential Diagnosis
The patient's presentation suggests several potential complications related to her pregnancy. The following differential diagnosis is organized into categories based on the likelihood and potential impact of each condition.
Single most likely diagnosis
- Placenta accreta spectrum (PAS) disorders: The presence of a low-lying placenta with numerous lacunae and myometrial thinning, as seen on ultrasound, is highly suggestive of placenta accreta spectrum disorders. This condition is characterized by abnormal placental attachment to the uterus, which can lead to severe bleeding during pregnancy or postpartum.
Other Likely diagnoses
- Placenta previa: Although the placenta is described as low-lying, the presence of numerous lacunae and myometrial thinning may also increase the risk for placenta previa, where the placenta partially or completely covers the internal cervical os.
- Gestational hypertension: The patient's blood pressure is elevated at 126/84 mmHg, which may indicate the development of gestational hypertension, a condition that can lead to preeclampsia if left untreated.
Do Not Miss
- Uterine rupture: Given the patient's history of two prior dilation and curettage (D&C) procedures, there is a slight risk of uterine rupture, especially if the placenta accreta spectrum disorder is severe. Uterine rupture is a life-threatening emergency that requires immediate attention.
- Preeclampsia with severe features: While the patient's current blood pressure is not severely elevated, the risk of developing preeclampsia with severe features (e.g., severe hypertension, proteinuria, or end-organ damage) should not be overlooked, as it can have devastating consequences for both the mother and the fetus.
Rare diagnoses
- Vasa previa: Although less likely, the presence of a low-lying placenta and breech presentation may increase the risk for vasa previa, a condition where fetal blood vessels are exposed in the lower uterine segment, unprotected by Wharton's jelly.
- Uterine dehiscence: This is a rare condition where there is a partial separation of the uterine scar, which can occur in women with a history of uterine surgery, such as D&C procedures. However, it is less likely than uterine rupture.