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.
- Endometritis without retained products of conception: The patient's symptoms and history of intraamniotic infection make endometritis a possible diagnosis, even if retained products of conception are not present.
- Do Not Miss
- Uterine rupture or dehiscence: Although rare, uterine rupture or dehiscence is a life-threatening condition that requires immediate attention. The patient's history of prolonged labor and abdominal cramping warrants consideration of this diagnosis.
- Hematologic disorders (e.g., disseminated intravascular coagulation): These conditions can cause significant bleeding and are potentially life-threatening if not recognized and treated promptly.
- Invasive placental disorders (e.g., placenta accreta): Although the patient had a vaginal delivery, invasive placental disorders can still occur and cause significant bleeding.
- Rare diagnoses
- Uterine artery pseudoaneurysm: This is a rare condition that can cause postpartum hemorrhage, but it is less likely given the patient's presentation and history.
- Arteriovenous malformation: This is another rare condition that can cause postpartum hemorrhage, but it is less likely and would require further evaluation to diagnose.