Differential Diagnosis for Postpartum Hemorrhage
- Single most likely diagnosis
- Postpartum endometritis with retained products of conception: This diagnosis is likely due to the patient's history of intraamniotic infection treated with intravenous antibiotics during labor, followed by increased vaginal bleeding and abdominal cramping. The presence of large clots and active bleeding from the cervical os supports this diagnosis.
- Other Likely diagnoses
- Uterine atony: Although the uterus is firm and nontender, uterine atony cannot be completely ruled out, especially given the patient's history of prolonged labor and delivery of a large infant.
- Postpartum hemorrhage due to laceration or trauma: The patient's history of vaginal delivery and passage of large clots raises the possibility of a laceration or trauma contributing to the bleeding.
- Do Not Miss
- Placenta accreta spectrum (PAS) disorders: Although less likely, PAS disorders can cause life-threatening bleeding and should be considered, especially given the patient's history of gestational diabetes mellitus and prolonged labor.
- Uterine rupture or dehiscence: This is a rare but potentially life-threatening condition that should be considered, especially if the patient's symptoms worsen or if there are signs of uterine tenderness or instability.
- Invasive hemodynamic monitoring or coagulopathy: The patient's increased bleeding and abdominal cramping may be indicative of a coagulopathy or other hemodynamic instability, which would require prompt recognition and treatment.
- Rare diagnoses
- Malignant gestational trophoblastic disease: This rare condition can cause postpartum bleeding and should be considered if other diagnoses are ruled out and the patient's symptoms persist.
- Arteriovenous malformation: This rare vascular anomaly can cause postpartum bleeding and should be considered if other diagnoses are ruled out and the patient's symptoms persist.