Differential Diagnosis for a 32-year-old Pregnant Woman with Vaginal Bleeding
Single Most Likely Diagnosis
- Ectopic Pregnancy: This is the most likely diagnosis given the patient's symptoms of vaginal bleeding, a dilated cervix, and an empty uterus on ultrasound. The presence of an empty uterus with no evidence of uterine pregnancy, combined with the patient's early pregnancy and symptoms, strongly suggests an ectopic pregnancy.
Other Likely Diagnoses
- Spontaneous Abortion (Miscarriage): Although the ultrasound shows an empty uterus, it's possible that the patient had a miscarriage and the products of conception have been partially or completely expelled. However, the presence of a dilated cervix and bleeding makes ectopic pregnancy more likely.
- Molar Pregnancy: A molar pregnancy could potentially cause vaginal bleeding and an empty uterus on ultrasound if the molar tissue has been expelled. However, this diagnosis is less likely given the patient's symptoms and ultrasound findings.
Do Not Miss Diagnoses
- Ruptured Ectopic Pregnancy: This is a life-threatening condition that requires immediate medical attention. If the ectopic pregnancy has ruptured, the patient may present with severe abdominal pain, heavy bleeding, and hemodynamic instability.
- Heterotopic Pregnancy: Although rare, a heterotopic pregnancy (where one embryo implants in the uterus and another outside the uterus) can occur, especially in women undergoing fertility treatments. This diagnosis is critical to consider, as it can be life-threatening if the ectopic pregnancy ruptures.
Rare Diagnoses
- Pseudosarcina (False Pregnancy) or Phantom Pregnancy: This is a rare condition where a woman believes she is pregnant, but there is no actual pregnancy. However, this diagnosis does not explain the patient's vaginal bleeding and ultrasound findings.
- Corpus Luteum Cyst Rupture: A ruptured corpus luteum cyst can cause vaginal bleeding and pelvic pain, but it is less likely to cause a dilated cervix and an empty uterus on ultrasound.