Differential Diagnosis for a 32-year-old Primigravida at 28 Weeks Gestation
- Single most likely diagnosis:
- Preterm labor: This is the most likely diagnosis given the patient's symptoms of painful contractions, cervical dilation, and effacement at 28 weeks gestation. The administration of betamethasone (a corticosteroid to promote fetal lung maturity) and indomethacin (a nonsteroidal anti-inflammatory drug to inhibit labor) also suggests that preterm labor is the primary concern.
- Other Likely diagnoses:
- False labor (Braxton Hicks contractions): Although the patient is experiencing painful contractions and cervical changes, false labor could be considered if the contractions are irregular, do not lead to progressive cervical dilation, or if there are other factors suggesting this diagnosis.
- Cervical insufficiency: Given the patient's cervical dilation and effacement without a history of prolonged rupture of membranes or other risk factors, cervical insufficiency could be a contributing factor to her presentation.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Placental abruption: Although the patient does not have vaginal bleeding, placental abruption can present with painful contractions and should be considered, especially if the patient's condition worsens or if there are concerns about fetal well-being.
- Uterine rupture: This is a rare but life-threatening condition that could present with severe abdominal pain and contractions, especially in a patient with a previous uterine scar (although not mentioned in this case).
- Rare diagnoses:
- Uterine dehiscence: Similar to uterine rupture, this is a rare condition where there is a partial separation of a previous uterine scar, which could present with painful contractions and should be considered in the differential diagnosis, especially if the patient has a history of uterine surgery.
- Chorioamnionitis: This is an infection of the fetal membranes (amnion and chorion) that could present with contractions, fever, and other signs of infection. Although the patient's temperature is normal, this diagnosis should be considered if her condition changes or if there are other signs of infection.