What is the diagnosis for a 34-year-old woman, gravida (number of times pregnant) 2, para (number of viable births) 1, at 26 weeks gestation, presenting with intermittent leakage of fluid, fever (hyperthermia), tachycardia, uterine tenderness, and purulent amniotic fluid, with a history of preterm prelabor rupture of membranes (PROM) in a previous pregnancy?

Differential Diagnosis

• Single most likely diagnosis
  • Preterm premature rupture of membranes (PPROM) with intra-amniotic infection: This diagnosis is most likely due to the patient's history of preterm prelabor rupture of membranes, the presence of purulent amniotic fluid, and the patient's symptoms of fever and uterine tenderness.
• Other Likely diagnoses
  • Preterm labor: Although the patient denies contractions, the presence of a fever and uterine tenderness could indicate an underlying infection that may progress to preterm labor.
  • Chorioamnionitis: The patient's symptoms of fever, uterine tenderness, and purulent amniotic fluid are consistent with chorioamnionitis, an infection of the fetal membranes.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Placental abruption: Although the patient denies vaginal bleeding, placental abruption can present with uterine tenderness and fetal distress, and is a life-threatening condition that requires prompt diagnosis and treatment.
  • Uterine rupture: Given the patient's history of previous preterm prelabor rupture of membranes and potential uterine scar, uterine rupture is a rare but potentially life-threatening complication that must be considered.
• Rare diagnoses
  • Amniotic fluid embolism: Although rare, amniotic fluid embolism can occur in the setting of ruptured membranes and is a life-threatening condition that requires prompt diagnosis and treatment.
  • Listiosis: The patient's symptoms of fever and uterine tenderness could be consistent with listiosis, a rare but serious infection that can occur during pregnancy.