Differential Diagnosis for Postpartum Vaginal Bleeding
- Single most likely diagnosis
- Lochia: This is the most likely diagnosis given the patient's recent childbirth and the description of the bleeding as light and dark red or brown, which is consistent with lochia, a normal postpartum discharge.
- Other Likely diagnoses
- Endometritis: Although the patient does not have symptoms such as fever or uterine tenderness, endometritis is a possible cause of postpartum bleeding, especially after a cesarean delivery.
- Retained products of conception: This condition can cause bleeding and is a consideration in any postpartum patient with persistent bleeding, although the absence of heavy bleeding or clots makes it less likely.
- Atrophy of the vaginal or cervical mucosa: This can occur due to hormonal changes postpartum and breastfeeding, leading to light bleeding.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Uterine rupture or dehiscence: Although rare, especially in the absence of severe symptoms, this is a life-threatening condition that requires immediate attention.
- Postpartum hemorrhage (delayed): This can occur due to various causes, including retained products of conception or infection, and is a medical emergency.
- Malignancy (e.g., cervical or endometrial cancer): Although unlikely in a young patient with a recent normal Pap test, any postpartum bleeding warrants consideration of underlying malignancy, especially if risk factors are present.
- Rare diagnoses
- Arteriovenous malformation (AVM): A rare cause of postpartum bleeding that can be life-threatening if not recognized and treated promptly.
- Invasive placenta (e.g., placenta accreta): Typically presents with severe bleeding, but a rare case might present with more subtle symptoms.
- Coagulopathy: A bleeding disorder could present with postpartum bleeding, although this would be unusual without a prior history of bleeding disorders.