Differential Diagnosis for Postpartum Perineal Pain
- Single most likely diagnosis
- Urinary Retention: The patient's increasing perineal pain, particularly with voiding, suggests urinary retention, which is a common issue postpartum, especially after a prolonged second stage of labor and perineal trauma. The edema of the perineum and labia majora could also contribute to discomfort and difficulty in urinating.
- Other Likely diagnoses
- Perineal Hematoma: Given the patient's recent perineal laceration and repair, a perineal hematoma is a possible cause of her increasing pain. Although the laceration repair appears intact, a hematoma could have formed beneath the repair site.
- Infection (Early Signs): While the patient does not have a fever or purulent drainage, early signs of infection could manifest as increased pain and tenderness at the site of the laceration repair.
- Urethral Trauma: The patient's pain with voiding could also suggest urethral trauma, which might have occurred during the delivery or as a complication of the perineal laceration.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Septic Pelvic Thrombophlebitis: Although rare, this condition is life-threatening and can present with nonspecific symptoms such as pain. It's crucial to consider in the differential diagnosis of postpartum pain.
- Necrotizing Fasciitis: This is a rare but deadly infection that can occur after perineal trauma. Early recognition and treatment are critical for survival.
- Rare diagnoses
- Vesicovaginal Fistula: While more commonly associated with prolonged labor or obstetric trauma, a vesicovaginal fistula could present with pain and urinary symptoms, although it would be less likely to present so early postpartum.
- Pudendal Nerve Injury: Injury to the pudendal nerve during delivery could result in perineal pain and urinary retention, although this would be a less common cause of the patient's symptoms.