Differential Diagnosis for Vaginal Bleeding and Constant Back Pain in a 36-year-old Woman at 35 Weeks Gestation
- Single most likely diagnosis:
- Placental abruption: This condition is characterized by vaginal bleeding, constant back pain, and fetal distress, which are all present in this patient. The presence of late decelerations on fetal monitoring also supports this diagnosis.
- Other Likely diagnoses:
- Uterine rupture: Although less likely given the patient's history and physical examination, uterine rupture can cause vaginal bleeding, back pain, and fetal distress. However, it is more commonly associated with a history of uterine surgery or previous uterine rupture.
- Preterm labor: The patient is experiencing uterine contractions every 1-2 minutes, which could indicate preterm labor. However, the presence of vaginal bleeding and fetal distress makes this diagnosis less likely.
- Do Not Miss diagnoses:
- Placenta previa: Although the patient has a closed cervix and only a small amount of bleeding, placenta previa can cause sudden and severe bleeding. It is essential to consider this diagnosis to avoid missing a potentially life-threatening condition.
- Uteroplacental insufficiency: This condition can cause fetal distress and late decelerations, and it may be related to the patient's history of chronic hypertension.
- Rare diagnoses:
- Vasa previa: This condition involves the fetal blood vessels crossing over the internal cervical os, which can cause vaginal bleeding and fetal distress. However, it is relatively rare and usually associated with other placental abnormalities.
- Uterine dehiscence: This condition involves a partial separation of the uterine scar, which can cause back pain and vaginal bleeding. However, it is less common than uterine rupture and usually occurs in women with a history of uterine surgery.