Differential Diagnosis for a 22-year-old Woman at 37 Weeks Gestation
- Single most likely diagnosis:
- Fetal distress due to uteroplacental insufficiency: This is the most likely diagnosis given the presence of late decelerations on the fetal heart rate tracing, which is indicative of uteroplacental insufficiency and potential fetal distress. The meconium-stained amniotic fluid also supports this diagnosis, as it can be a sign of fetal distress.
- Other Likely diagnoses:
- Infection (chorioamnionitis): Although the patient's temperature is currently normal, the presence of meconium-stained amniotic fluid and the patient's symptoms could be indicative of an underlying infection. The patient's group B Streptococcus culture was negative, but this does not rule out other types of infections.
- Umbilical cord compression: The presence of meconium-stained amniotic fluid and variable fetal heart rate decelerations (although not explicitly mentioned, could be considered given the clinical context) could suggest umbilical cord compression. However, the consistent pattern of late decelerations points more towards uteroplacental insufficiency.
- Do Not Miss diagnoses:
- Placental abruption: This is a life-threatening condition that requires immediate attention. Although the patient has not reported any vaginal bleeding, a placental abruption can sometimes present without overt bleeding, especially if the abruption is marginal or the bleeding is concealed.
- Uterine rupture: Given the patient's history of no previous surgeries, this is less likely, but it is still a critical diagnosis to consider, especially if there are any signs of severe abdominal pain or sudden fetal distress.
- Rare diagnoses:
- Amniotic fluid embolism: This is a rare but potentially life-threatening condition. The presence of meconium-stained amniotic fluid and the patient's symptoms could be indicative of an amniotic fluid embolism, although this would typically present with more severe maternal symptoms such as hypotension and respiratory distress.
- Fetal cardiac anomalies: Although not directly suggested by the information provided, fetal cardiac anomalies could potentially cause abnormal fetal heart rate patterns. However, this would typically be identified during prenatal ultrasound evaluations.