Differential Diagnosis for Abdominal Pain Five Weeks After a Routine Vaginal Delivery
Single Most Likely Diagnosis
- Uterine involution pain or afterpains: This condition is common in the postpartum period, especially during the first few weeks after delivery. The pain is usually mild to moderate and can be associated with breastfeeding. It's a normal part of the uterus returning to its pre-pregnancy size.
Other Likely Diagnoses
- Constipation: Postpartum constipation is common due to hormonal changes, pain from episiotomy or tears, and the use of pain medications. It can cause significant abdominal pain and discomfort.
- Urinary Tract Infection (UTI): UTIs are more common in the postpartum period due to urethral trauma during delivery and the potential for catheterization. Symptoms include dysuria, frequency, and abdominal pain.
- Ovarian cysts: These can rupture or cause pain due to torsion, especially in the postpartum period when hormonal changes may influence ovarian function.
Do Not Miss Diagnoses
- Postpartum hemorrhage (late): Although less common than immediate postpartum hemorrhage, late postpartum hemorrhage can occur several weeks after delivery due to retained placental tissue or infection. It's a medical emergency.
- Pulmonary embolism: This is a rare but potentially life-threatening condition that can occur in the postpartum period due to increased coagulability of blood. Symptoms include sudden onset of chest pain and shortness of breath.
- Infection (endometritis, parametritis): Infections of the uterus or surrounding tissues can cause abdominal pain, fever, and other systemic symptoms. They require prompt antibiotic treatment.
- Appendicitis: Although not specific to the postpartum period, appendicitis is a surgical emergency that can present with abdominal pain and must be considered in the differential diagnosis.
Rare Diagnoses
- Adrenal hemorrhage: A rare condition that can cause abdominal pain, usually associated with other systemic symptoms like hypotension and shock.
- Splenic rupture or infarct: These are rare conditions that can cause severe abdominal pain and are associated with significant morbidity if not promptly diagnosed and treated.
- Hepatic rupture or hemorrhage: Rare complications, potentially associated with severe abdominal pain, and require immediate medical attention.