What is the diagnosis for a 36-year-old woman, gravida (number of times pregnant) 1, para (number of viable births) 0, at 38 weeks gestation, presenting with spontaneous rupture of membranes (SROM) 48 hours prior, prolonged labor, fever (hyperthermia), tachycardia, and a fetal heart rate (FHR) tracing showing a normal Category I pattern with moderate baseline variability and absent accelerations?

Differential Diagnosis

• Single most likely diagnosis
  • Chorioamnionitis: This is the most likely diagnosis given the patient's symptoms, including fever (39.4 C), prolonged rupture of membranes (48 hours), and prolonged labor. Chorioamnionitis is an infection of the fetal membranes and amniotic fluid, which can occur after prolonged rupture of membranes.
• Other Likely diagnoses
  • Prolonged labor: The patient has been experiencing contractions for over 12 hours and has been 6 cm dilated for 5 hours, which suggests a prolonged labor.
  • Intrauterine infection: The patient's symptoms, including fever and prolonged rupture of membranes, also suggest an intrauterine infection.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Placental abruption: Although the patient reports regular fetal movement and intermittent vaginal spotting, placental abruption is a life-threatening condition that requires prompt diagnosis and treatment.
  • Uterine rupture: Given the patient's prolonged labor and previous attempt at a home birth, uterine rupture is a possibility, especially if the patient has a pre-existing uterine scar.
• Rare diagnoses
  • Amniotic fluid embolism: Although rare, amniotic fluid embolism is a life-threatening condition that can occur after rupture of membranes.
  • Group B streptococcal sepsis: The patient's symptoms, including fever and prolonged rupture of membranes, may also suggest group B streptococcal sepsis, although this is less likely.