Differential Diagnosis for Vaginal Bleeding in Early Pregnancy
- Single Most Likely Diagnosis
- Anembryonic gestation: The transvaginal ultrasound reveals a gestational sac of 19 mm in diameter without a visible embryo. Given that the quantitative B-HCG level is 14,000 mIU/mL and the last menstrual period was 11 weeks ago, the absence of an embryo at this stage is highly suggestive of an anembryonic gestation, where the gestational sac develops without an embryo.
- Other Likely Diagnoses
- Missed abortion: This condition is characterized by the retention of a failed pregnancy, which can present with vaginal bleeding and a closed cervix. The ultrasound finding of a gestational sac without an embryo could also be consistent with a missed abortion, especially if the embryo had already demised.
- Incomplete abortion: Although the cervix is closed and there are no adnexal masses, incomplete abortion remains a possibility if the patient had a recent episode of bleeding that led to the expulsion of some but not all pregnancy tissue. However, the ultrasound description does not directly support this diagnosis.
- Threatened abortion: This diagnosis refers to vaginal bleeding during the first 20 weeks of pregnancy without cervical dilation or passage of tissue. While the patient presents with vaginal bleeding, the absence of an embryo on ultrasound shifts the likelihood towards other diagnoses.
- Do Not Miss Diagnoses
- Ectopic pregnancy: Although the ultrasound shows a gestational sac in the uterus, an ectopic pregnancy cannot be entirely ruled out without seeing an embryo or a yolk sac within the gestational sac. Ectopic pregnancy is a life-threatening condition that requires prompt diagnosis and treatment.
- Rare Diagnoses
- Molar pregnancy: This condition is characterized by abnormal trophoblastic proliferation and can present with vaginal bleeding and an enlarged uterus. However, the ultrasound description provided does not support this diagnosis, as molar pregnancies typically show a "snowstorm" appearance on ultrasound due to the presence of hydropic villi, which was not mentioned.