Differential Diagnosis
- Single most likely diagnosis
- Uterine rupture: This is the most likely diagnosis given the sudden onset of abdominal pain, change in fetal station, and the patient's history of previous cesarean delivery. The pain initially being intermittent and then becoming constant, along with the fetal heart rate tracing abnormalities, further supports this diagnosis.
- Other Likely diagnoses
- Uterine dehiscence: Similar to uterine rupture, dehiscence is a possible complication in a patient with a previous cesarean delivery, especially with the symptoms of abdominal pain and change in fetal station. However, it might not present as dramatically as a rupture.
- Placental abruption: The sudden onset of abdominal pain and the presence of variable decelerations could suggest placental abruption, although the resolution of decelerations with amnioinfusion and the specific change in fetal station make this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Amniotic fluid embolism: Although less likely, amniotic fluid embolism is a catastrophic condition that can present with sudden onset of pain, hypotension, and fetal distress. It's crucial to consider this diagnosis due to its high mortality rate.
- Uterine inversion: This is a rare but life-threatening condition that could occur during delivery, especially with excessive traction on the umbilical cord or mismanagement of the third stage of labor. The sudden onset of pain and potential hemodynamic instability could be indicative of uterine inversion.
- Rare diagnoses
- Vasa previa: Although the patient has reached full dilation and the fetal vertex has moved, vasa previa could still be considered if there's a sudden onset of fetal distress without a clear cause, especially if there's a history suggestive of placental anomalies.
- Retained products of conception: This would be less likely given the patient's stage of labor but could be considered if there's a sudden change in the patient's condition without an obvious cause related to the labor process itself.