Differential Diagnosis
- Single most likely diagnosis
- Placental abruption: This condition is characterized by the separation of the placenta from the uterus, which can cause painless vaginal bleeding, rupture of membranes, and fetal distress. The patient's history of hypertension and lack of prenatal care increase her risk for this condition. The presence of bloody fluid after the rupture of membranes and the inability to detect fetal heart tones on Doppler ultrasound support this diagnosis.
- Other Likely diagnoses
- Uterine rupture: Given the patient's history of two previous cesarean deliveries, uterine rupture is a possible diagnosis, especially if the patient had a classical incision or a previous uterine rupture. However, the patient's symptoms and the nontender uterus make this diagnosis less likely.
- Placenta previa: This condition, where the placenta covers the cervical os, can cause painless vaginal bleeding. However, the patient's symptoms of rupture of membranes and the presence of bloody fluid make placental abruption more likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Uterine dehiscence: Similar to uterine rupture, uterine dehiscence is a possible diagnosis given the patient's history of previous cesarean deliveries. Although less likely, it is crucial to consider this diagnosis due to its potential severity.
- Amniotic fluid embolism: Although rare, amniotic fluid embolism is a life-threatening condition that can occur after rupture of membranes. The patient's symptoms of rupture of membranes and the presence of bloody fluid make this diagnosis possible, albeit unlikely.
- Rare diagnoses
- Vasa previa: This condition, where fetal blood vessels are present in the membranes covering the cervical os, can cause vaginal bleeding and fetal distress after rupture of membranes. However, this diagnosis is rare and less likely given the patient's symptoms and history.
- Fetal demise: Although the inability to detect fetal heart tones on Doppler ultrasound raises concerns about fetal well-being, fetal demise is a rare diagnosis in this scenario, especially given the patient's report of normal fetal movement earlier in the day.