Differential Diagnosis for Spontaneous Miscarriage
Single Most Likely Diagnosis
- Missed Abortion: The decrease in serum HCG levels over time, although not as rapid as expected in a normal pregnancy, suggests a non-viable pregnancy. The initial HCG level was 6586, and 19 days later, it decreased to 5258, indicating a possible failed pregnancy.
Other Likely Diagnoses
- Incomplete Miscarriage: The patient may have experienced some bleeding and tissue loss, but some products of conception may still be present in the uterus, leading to a slower decline in HCG levels.
- Ectopic Pregnancy: Although less likely given the initial HCG level, an ectopic pregnancy could still be a possibility, especially if the patient is experiencing symptoms such as abdominal pain or vaginal bleeding.
- Multiple Pregnancy Loss: If the patient was carrying twins or multiple gestations, the loss of one or more fetuses could lead to a decrease in HCG levels.
Do Not Miss Diagnoses
- Ectopic Pregnancy Rupture: Although less likely, a ruptured ectopic pregnancy is a life-threatening condition that requires immediate attention. The patient's symptoms and HCG levels should be carefully evaluated to rule out this possibility.
- Molar Pregnancy: A molar pregnancy can cause abnormal HCG levels, and although rare, it is essential to consider this diagnosis to avoid missing a potentially life-threatening condition.
Rare Diagnoses
- Pregnancy with a Chromosomal Abnormality: Some chromosomal abnormalities, such as triploidy, can cause abnormal HCG levels and an increased risk of miscarriage.
- Heterotopic Pregnancy: A rare condition where a woman has both an intrauterine and an ectopic pregnancy, which can lead to abnormal HCG levels and an increased risk of complications.