Differential Diagnosis
- Single most likely diagnosis
- Preterm labor with rupture of membranes (ROM) and meconium-stained amniotic fluid: This diagnosis is the most likely due to the patient's symptoms of leakage of fluid, painful contractions, and the presence of meconium-stained fluid in the vagina. The patient's cervix is 6 cm dilated, indicating active labor.
- Other Likely diagnoses
- Term labor with ROM and meconium-stained amniotic fluid: Although the patient is at 37 weeks gestation, which is considered term, the presence of meconium-stained fluid and the patient's symptoms suggest that labor may be progressing.
- Chorioamnionitis: The patient's history of continuous vaginal leakage of clear fluid for the past 2 days, followed by the appearance of green fluid, may indicate an intrauterine infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Placental abruption: Although the patient's symptoms do not strongly suggest placental abruption, the presence of meconium-stained fluid and painful contractions warrants consideration of this diagnosis, as it can be life-threatening for both the mother and the fetus.
- Uterine rupture: Given the patient's history of multiple prior vaginal deliveries, there is a small risk of uterine rupture, which would be a medical emergency.
- Rare diagnoses
- Amniotic fluid embolism: This rare but potentially life-threatening condition can occur when amniotic fluid enters the maternal circulation, causing a severe reaction.
- Vasa previa: Although rare, vasa previa can cause significant fetal bleeding and is a life-threatening condition that requires prompt diagnosis and treatment.