Differential Diagnosis for 22-year-old Female with Pelvic Cramping and Positive Pregnancy Test
- Single most likely diagnosis:
- Spontaneous Abortion (Miscarriage): The patient's symptoms of pelvic cramping, light spotting, and bleeding, combined with a positive home pregnancy test and a low BHCG level of 80, are highly suggestive of a spontaneous abortion. The mild suprapubic tenderness and dried brown-red blood on pelvic exam further support this diagnosis.
- Other Likely diagnoses:
- Ectopic Pregnancy: Although less likely given the presence of some uterine bleeding, ectopic pregnancy must be considered, especially with a positive pregnancy test and pelvic pain. However, the BHCG level is relatively low for a typical ectopic pregnancy presentation.
- Threatened Abortion: This condition is characterized by vaginal bleeding with or without cramping in a pregnant woman, but the cervix is closed, and the fetus is viable. The patient's symptoms could fit this diagnosis if the pregnancy is still viable, but the low BHCG level and presence of bleeding suggest a non-viable pregnancy.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Ruptured Ectopic Pregnancy: Although the patient's presentation does not strongly suggest a ruptured ectopic pregnancy (e.g., severe pain, significant bleeding, hypotension), this diagnosis is critical to rule out due to its high mortality rate if missed. The patient's symptoms and low BHCG level warrant careful consideration and possibly further evaluation (e.g., ultrasound).
- Ovarian Torsion: This condition can present with acute pelvic pain and may be associated with some vaginal bleeding. It is less likely given the context of a positive pregnancy test, but it requires prompt surgical intervention to preserve ovarian function.
- Rare diagnoses:
- Molar Pregnancy: This rare condition, characterized by abnormal trophoblastic proliferation, can present with vaginal bleeding and a positive pregnancy test. However, it typically presents with higher BHCG levels and more significant uterine size discrepancy.
- Corpus Luteum Cyst Rupture: Although this can cause acute pelvic pain and some bleeding, it is less likely in the context of a confirmed pregnancy and the specific symptoms presented.