Differential Diagnosis
- Single most likely diagnosis:
- Uterine rupture: This is the most likely diagnosis given the patient's history of a previous cesarean delivery, sudden onset of intense lower abdominal pain, and the presence of recurrent late decelerations on fetal heart monitoring. The fact that the fetal vertex is now at -3 station, indicating a possible upward displacement of the fetus due to uterine rupture, further supports this diagnosis.
- Other Likely diagnoses:
- Placental abruption: This condition is characterized by moderate to severe vaginal bleeding, abdominal pain, and fetal distress, which are all present in this patient. However, the presence of a previous cesarean delivery and the specific pattern of fetal heart rate tracing make uterine rupture more likely.
- Uterine dehiscence: This is a partial separation of the uterine scar, which can cause abdominal pain and vaginal bleeding. However, it may not always present with the same severity as uterine rupture.
- Do Not Miss diagnoses:
- Amniotic fluid embolism: Although less likely, this condition can present with sudden onset of abdominal pain, fetal distress, and maternal cardiovascular instability. It is a life-threatening condition that requires immediate attention.
- Placenta previa: This condition can cause vaginal bleeding and abdominal pain, and it is essential to rule it out, especially in a patient with a history of cesarean delivery.
- Rare diagnoses:
- Uterine inversion: This is a rare condition where the uterus turns inside out, which can cause abdominal pain, vaginal bleeding, and fetal distress. However, it is less likely in this scenario, given the patient's presentation and history.
- Vasa previa: This condition occurs when fetal blood vessels are present in the membranes covering the cervix, which can cause vaginal bleeding and fetal distress. However, it is relatively rare and less likely in this patient, given the absence of other risk factors.