A 31-Year-Old Primigravida at 7 Weeks Gestation Is Brought to the Emergency

A 31-year-old primigravida at 7 weeks gestation is brought to the emergency department by her husband due to vaginal bleeding and lower abdominal pain.  The bleeding began 4 hours earlier, and the patient has saturated 3 perineal pads in that time.  Her abdominal cramping has become progressively more severe and unresponsive to acetaminophen.  She has no fevers, chills, or abnormal vaginal discharge.  The patient was treated at age 18 for Chlamydia trachomatis cervicitis.  Her surgical history includes a loop electrode excision procedure for high-grade cervical intraepithelial neoplasia, but she has had normal Pap tests since.  The patient takes a prenatal vitamin daily and does not use tobacco, alcohol, or illicit drugs.  Temperature is 37 C (98.7 F) , blood pressure is 100/76 mm Hg, pulse is 112/min, and respirations are 14/min.  Pelvic examination reveals blood clots in the vaginal vault and active bleeding from a dilated cervix.  A bimanual examination demonstrates a 6-week-size tender uterus.  Ultrasound reveals a gestational sac in the lower segment of the uterus, a simple cyst in the right ovary, and free fluid in the posterior cul-de-sac.  Which of the following is the most likely diagnosis of this patient?

A) Acute cervicitis
B) Cervical insufficiency
C) Ectopic pregnancy
D) Hydatidiform mole
E) Inevitable abortion
F) Missed abortion
G) Threatened abortion

Correct Answer:

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