Differential Diagnosis
- Single most likely diagnosis
- Uterine inversion: The patient's symptoms of dizziness, lightheadedness, and hypotension, combined with the presence of a large, purple mass protruding into the vagina, are highly suggestive of uterine inversion. This is a serious complication that can occur after a forceps-assisted vaginal delivery, especially with a large infant.
- Other Likely diagnoses
- Postpartum hemorrhage (PPH): Although the patient has minimal blood on the perineal pad, PPH can still occur due to various causes such as uterine atony, retained placental tissue, or lacerations. The patient's hypotension and tachycardia could be indicative of blood loss.
- Uterine atony: This condition, where the uterus fails to contract after delivery, can lead to hemorrhage and hypotension. The firm, nontender uterus on examination makes this less likely, but it should still be considered.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Amniotic fluid embolism (AFE): Although the patient's symptoms do not strongly suggest AFE, it is a potentially life-threatening condition that can occur during labor or immediately postpartum. The presence of hypotension, tachycardia, and respiratory symptoms (even if not currently present) warrants consideration of this diagnosis.
- Pulmonary embolism (PE): The patient's symptoms of dizziness and lightheadedness, combined with tachycardia, could be indicative of a PE. This is a critical diagnosis to consider, especially in a postpartum patient with potential risk factors for thromboembolism.
- Rare diagnoses
- Uterine rupture: Although rare, uterine rupture can occur after a forceps-assisted vaginal delivery, especially if there were any complications during the procedure. The patient's symptoms and examination findings do not strongly suggest this diagnosis, but it should be considered in the differential.
- Placenta accreta spectrum (PAS) disorders: These conditions, where the placenta abnormally adheres to the uterus, can lead to severe postpartum hemorrhage and other complications. The patient's symptoms and examination findings do not strongly suggest PAS, but it is a rare diagnosis that should be considered in the differential.