Differential Diagnosis for 26 yo G3 A3 with 9 weeks pregnancy and recent embryo passage
- Single most likely diagnosis
- Ectopic pregnancy with rupture: The patient's presentation of pelvic pain, recent passage of an embryo, and lab results showing leukocytosis (elevated white blood cell count) and hypocarbia (low carbon dioxide levels in the blood, possibly indicating respiratory compensation for metabolic acidosis) are highly suggestive of a ruptured ectopic pregnancy. This condition is a medical emergency.
- Other Likely diagnoses
- Septic abortion: Given the patient's history of a recent embryo passage and symptoms of pelvic pain along with leukocytosis, septic abortion (infection of the uterus following a miscarriage) is a plausible diagnosis. However, the presence of a passed embryo might lean more towards a spontaneous abortion complication rather than an induced one.
- Spontaneous abortion with infection: Similar to septic abortion, if the embryo's passage was due to a spontaneous miscarriage, infection could have set in, causing the patient's symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ovarian torsion: Although less likely given the context of a recent embryo passage, ovarian torsion can cause severe pelvic pain and could potentially lead to leukocytosis due to associated inflammation or necrosis. It's a surgical emergency.
- Ruptured ovarian cyst: This condition can mimic the symptoms of a ruptured ectopic pregnancy, including severe pelvic pain and could potentially cause systemic symptoms like leukocytosis.
- Rare diagnoses
- Molar pregnancy with complications: Though rare, a molar pregnancy (abnormal growth of tissue in the uterus) could potentially cause the symptoms described, especially if there were complications such as infection or hemorrhage.
- Pelvic inflammatory disease (PID): While PID can cause pelvic pain and leukocytosis, it is less directly related to the recent passage of an embryo. However, it remains a consideration in the differential diagnosis, especially if sexually transmitted infections are a concern.