Differential Diagnosis for Postpartum Perineal Pain
- Single most likely diagnosis
- Hematoma: The patient's symptoms of increasing perineal pain, particularly with voiding, and the presence of a tender perineal laceration repair are consistent with a hematoma. The edema of the perineum and labia majora also supports this diagnosis.
- Other Likely diagnoses
- Urinary Retention: The patient's pain with voiding could be indicative of urinary retention, which is a common issue postpartum, especially after a prolonged second stage of labor and perineal trauma.
- Infection (early signs): Although the patient does not have a fever and there is no purulent drainage, early signs of infection could present with increased pain and tenderness, especially if the laceration repair is not healing as expected.
- Perineal swelling or edema: The patient's perineal and labial edema could be contributing to her pain, especially if the swelling is significant.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Necrotizing Fasciitis: Although rare, this condition is life-threatening and can present with severe pain out of proportion to the physical examination findings, making it crucial not to miss.
- Septic Pelvic Thrombophlebitis: This condition is a rare but serious complication that can occur postpartum, presenting with pain and possibly fever, and requires prompt diagnosis and treatment.
- Rare diagnoses
- Perineal abscess: While possible, especially if there was a complication with the laceration repair, the absence of purulent drainage and fever makes this less likely at this stage.
- Compartment Syndrome: This is a rare condition that could occur due to increased pressure within the perineal compartments, leading to severe pain and potentially serious complications if not addressed promptly.