Differential Diagnosis for Postpartum Lower Abdominal Pressure and Pain
- Single most likely diagnosis:
- Urinary Retention: The patient's inability to void since delivery and persistent urine dribbling while lying in bed are key indicators of urinary retention, a common complication postpartum, especially after epidural anesthesia and forceps-assisted delivery.
- Other Likely diagnoses:
- Postpartum Hematoma: Given the history of a forceps-assisted vaginal delivery and a second-degree perineal laceration, there's a risk of hematoma formation, which could cause lower abdominal pressure and pain.
- Uterine Atony: Although the uterine fundus is firm, and the postpartum hemorrhage was managed, uterine atony could still be a contributing factor to the patient's symptoms, especially if there's underlying uterine dysfunction.
- Infection (Endometritis): Early signs of infection could include lower abdominal tenderness and pain, even though the patient's temperature is currently normal.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Pulmonary Embolism: Although less common, pulmonary embolism is a life-threatening condition that could present with abdominal pain and should be considered, especially in a patient with risk factors such as recent pregnancy and possible immobility.
- Uterine Rupture: This is a rare but potentially catastrophic complication, especially in the context of a forceps-assisted delivery. It would require immediate surgical intervention.
- Septic Pelvic Thrombophlebitis: A rare condition that could present with persistent pelvic pain and signs of infection, which might not be immediately apparent.
- Rare diagnoses:
- Vesicovaginal Fistula: Although rare, this could be a consideration given the patient's symptoms of persistent urine dribbling, which might suggest an abnormal connection between the bladder and vagina.
- Ovarian Torsion: This is an uncommon condition but could occur postpartum and would present with severe abdominal pain.