Differential Diagnosis for Postpartum Urinary Retention
- Single most likely diagnosis
- Postpartum urinary retention: This condition is a common complication after childbirth, especially in patients who received epidural anesthesia during labor. The patient's inability to void a measurable amount of urine, despite the sensation of fullness and tenderness above the pubic symphysis, supports this diagnosis. The use of epidural anesthesia and intermittent catheterization during labor may have contributed to the development of urinary retention.
- Other Likely diagnoses
- Urinary tract injury (e.g., urethral or bladder trauma): Although the patient did not have any lacerations, the edema and tenderness in the perineal and vaginal areas could be indicative of a urinary tract injury. The patient's symptoms of urinary dribbling and inability to empty her bladder could be consistent with a urinary tract injury.
- Neurogenic bladder: The patient's epidural anesthesia during labor could have caused temporary nerve damage, leading to neurogenic bladder. However, the fact that sensation is intact in the lower extremities makes this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Urethral obstruction or kinking: This is a potentially life-threatening condition that requires immediate attention. Although the patient's symptoms do not strongly suggest urethral obstruction, it is essential to consider this diagnosis to prevent long-term complications.
- Bladder rupture: Although rare, bladder rupture is a serious condition that can occur during childbirth. The patient's symptoms of abdominal tenderness and urinary retention could be indicative of a bladder rupture, making it essential to rule out this diagnosis.
- Rare diagnoses
- Vesicovaginal fistula: This is a rare complication of childbirth, characterized by an abnormal connection between the bladder and vagina. Although the patient's symptoms do not strongly suggest a vesicovaginal fistula, it is essential to consider this diagnosis in the differential.
- Pelvic hematoma: A pelvic hematoma could be causing compression on the urinary tract, leading to urinary retention. Although this is a rare diagnosis, it is essential to consider it in the differential to prevent long-term complications.