Differential Diagnosis for Abdominal Pain in a 30-year-old Pregnant Woman
- Single most likely diagnosis:
- Placental abruption: The patient's severe abdominal pain, hypertension, and uterine tenderness are consistent with placental abruption, a condition where the placenta separates from the uterus. The history of tobacco use and lack of prenatal care increase her risk for this condition.
- Other Likely diagnoses:
- Preterm labor: The patient's contractions every 1-2 minutes and abdominal pain could indicate preterm labor, especially given her history of a previous cesarean delivery.
- Uterine rupture: Although less likely, the patient's history of a previous cesarean delivery and severe abdominal pain raise the possibility of uterine rupture, which is a life-threatening emergency.
- Peptic ulcer disease exacerbation: The patient's history of peptic ulcer disease and current abdominal pain could suggest an exacerbation of her condition, although the location and radiation of pain are atypical.
- Do Not Miss diagnoses:
- Eclampsia: Although the patient does not have a headache or vision changes, her hypertension and abdominal pain necessitate consideration of eclampsia, a condition that can rapidly progress to seizures and is life-threatening.
- Uterine dehiscence: Similar to uterine rupture, dehiscence (a partial tear) can occur, especially in a patient with a previous cesarean delivery, and requires prompt diagnosis and management.
- Ovarian torsion: Although less common during pregnancy, ovarian torsion can cause severe abdominal pain and requires immediate surgical intervention to preserve the ovary.
- Rare diagnoses:
- Hepatic rupture: A rare but life-threatening condition that can cause severe abdominal pain and is associated with pregnancy, particularly in the setting of preeclampsia or trauma.
- Acute fatty liver of pregnancy: A rare condition characterized by abdominal pain, nausea, and liver dysfunction, which can rapidly progress to liver failure if not recognized and managed promptly.