Differential Diagnosis for Postpartum Seizure and Hemorrhage
- Single most likely diagnosis:
- Postpartum hemorrhage (PPH) due to uterine atony, complicated by disseminated intravascular coagulation (DIC) and acute respiratory distress syndrome (ARDS). This diagnosis is most likely due to the patient's presentation with profuse vaginal bleeding, hypotension, and an enlarged, boggy uterus after delivery, which are all characteristic of uterine atony leading to PPH. The seizure could be attributed to the severe hypotension and hypoxia resulting from the hemorrhage.
- Other Likely diagnoses:
- Amniotic fluid embolism (AFE): This condition can cause sudden onset of hypotension, hypoxia, and either cardiac arrest or seizures, which fits the patient's presentation. However, the presence of profuse vaginal bleeding and a boggy uterus makes PPH due to uterine atony a more direct explanation for the patient's condition.
- Pulmonary embolism: Although less likely given the immediate postpartum context and the presence of vaginal bleeding, pulmonary embolism could explain the sudden onset of respiratory distress and hypoxia. However, it would not directly account for the uterine atony and profuse bleeding.
- Do Not Miss diagnoses:
- Eclampsia: Although the patient's seizure occurred postpartum, eclampsia can occur up to 4 weeks postpartum. The presence of hypertension is not mentioned, but the seizure and the context of recent delivery make it crucial to consider and rule out eclampsia.
- Placenta accreta spectrum (PAS) disorders: These conditions can cause severe postpartum hemorrhage and are associated with significant morbidity and mortality. The patient's history of multiple pregnancies increases her risk for PAS disorders.
- Rare diagnoses:
- Air embolism: This could occur during delivery or postpartum procedures and could explain the sudden onset of hypoxia and cardiovascular collapse. However, it is less likely and would not directly explain the uterine atony and bleeding.
- Peripartum cardiomyopathy: This rare condition can cause heart failure and could potentially lead to embolic events or acute respiratory distress. However, the primary presentation would more likely involve cardiac symptoms rather than seizures and profuse bleeding.