Differential Diagnosis
- Single most likely diagnosis:
- Placental abruption: This is the most likely diagnosis given the sudden onset of heavy vaginal bleeding, constant abdominal pain, and uterine tenderness after the rupture of membranes. The patient's risk factors, such as severe polyhydramnios, also increase the likelihood of placental abruption.
- Other Likely diagnoses:
- Uterine rupture: Although less likely than placental abruption, uterine rupture is a possible diagnosis given the patient's severe abdominal pain, uterine tenderness, and the presence of a high-risk condition (severe polyhydramnios). However, the fact that the patient is not having a trial of labor after a previous cesarean section makes this diagnosis less likely.
- Posterior placenta previa: The patient's posterior fundal placenta and severe vaginal bleeding could suggest a placenta previa, especially if the placenta has migrated downward. However, the absence of prenatal bleeding and the specific location of the placenta make this diagnosis less likely.
- Do Not Miss diagnoses:
- Uterine dehiscence: This is a life-threatening condition that requires immediate attention. Although less likely than uterine rupture, uterine dehiscence can present with similar symptoms, such as severe abdominal pain and vaginal bleeding.
- Amniotic fluid embolism: This rare but deadly condition can occur after the rupture of membranes and is characterized by sudden onset of hypotension, hypoxia, and coagulopathy. Although the patient's vital signs are currently stable, this diagnosis should not be missed.
- Rare diagnoses:
- Vasa previa: This condition, where fetal blood vessels are present in the membranes covering the cervix, can cause severe vaginal bleeding after the rupture of membranes. However, the patient's posterior fundal placenta and lack of prenatal suspicion make this diagnosis less likely.
- Placenta accreta spectrum: This condition, characterized by abnormal placental implantation, can cause severe vaginal bleeding and uterine tenderness. However, the patient's posterior fundal placenta and lack of prenatal suspicion make this diagnosis less likely.