Differential Diagnosis for a 32-year-old woman at 35 weeks gestation with frequent, painful uterine contractions
- Single most likely diagnosis:
- Preterm labor: This is the most likely diagnosis given the patient's symptoms of frequent, painful uterine contractions, a visibly dilated cervix, and a history of a shortened cervix. The use of vaginal progesterone suggests that the patient was at high risk for preterm labor, and the current clinical presentation is consistent with this diagnosis.
- Other Likely diagnoses:
- False labor (Braxton Hicks contractions): Although the patient's contractions are painful and the cervix is dilated, false labor is still a possibility, especially if the contractions are irregular and do not lead to further cervical dilation.
- Premature rupture of membranes (PROM) with a high presenting part: Although there is no evidence of membrane rupture on speculum examination, it is still possible that the membranes are intact but the patient is at risk for rupture due to the advanced cervical dilation.
- Do Not Miss diagnoses:
- Placental abruption: This is a life-threatening condition that can cause painful uterine contractions and vaginal bleeding. Although the patient does not have vaginal bleeding, placental abruption can still occur without bleeding, and it is essential to consider this diagnosis to avoid missing it.
- Uterine rupture: Although the patient has not had any previous uterine surgery, uterine rupture can still occur, especially in the setting of a shortened cervix and preterm labor. This diagnosis is critical to consider due to its high morbidity and mortality.
- Rare diagnoses:
- Cervical stenosis: This is a rare condition where the cervix is narrow and can cause obstructed labor. Although the patient's cervix is dilated, cervical stenosis could be a contributing factor to the patient's symptoms.
- Uterine dehiscence: This is a rare condition where there is a partial separation of the uterine muscle, which can cause painful uterine contractions and vaginal bleeding. Although the patient does not have vaginal bleeding, uterine dehiscence is still a possibility, especially in the setting of a shortened cervix and preterm labor.