Differential Diagnosis
- Single most likely diagnosis
- Placenta previa: This is the most likely diagnosis given the patient's presentation of vaginal bleeding, rupture of membranes, and ultrasound findings of placental tissue covering the cervix. The presence of small blood clots at the cervical os and the patient's history of no prenatal care also support this diagnosis.
- Other Likely diagnoses
- Premature rupture of membranes (PROM): The patient's symptoms of fluid leakage and confirmed rupture of membranes on speculum examination make PROM a likely diagnosis. However, the presence of placental tissue covering the cervix and vaginal bleeding suggest that placenta previa is a more likely primary diagnosis.
- Placental abruption: Although the patient has vaginal bleeding, the absence of severe abdominal pain and the ultrasound findings of placental tissue covering the cervix make placental abruption less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Uterine rupture: Although the patient has had previous vaginal deliveries, the lack of prenatal care and potential for undiagnosed uterine anomalies or scars make uterine rupture a possibility that should not be missed.
- Amniotic fluid embolism: The patient's symptoms of fluid leakage and rupture of membranes increase the risk of amniotic fluid embolism, which is a life-threatening condition.
- Hemorrhage due to other causes (e.g., uterine atony, lacerations): The patient's vaginal bleeding and history of no prenatal care make it essential to consider other potential causes of hemorrhage.
- Rare diagnoses
- Vasa previa: Although the patient has vaginal bleeding and rupture of membranes, the absence of fetal distress and the ultrasound findings make vasa previa less likely.
- Placenta accreta: The patient's presentation and ultrasound findings do not strongly suggest placenta accreta, but it is a rare condition that should be considered in the differential diagnosis.