Differential Diagnosis for Vaginal Bleeding and Pelvic Cramping
Single Most Likely Diagnosis
- Spontaneous Abortion (Miscarriage): The patient's presentation of vaginal bleeding, pelvic cramping, a positive pregnancy test, and a dilated open cervix with visible tissue is highly suggestive of a spontaneous abortion. The timing, eight weeks after the last menstrual period, is also consistent with this diagnosis.
Other Likely Diagnoses
- Ectopic Pregnancy: Although less likely given the visible tissue in the cervix, an ectopic pregnancy cannot be ruled out without further imaging. Ectopic pregnancies can present with similar symptoms and a positive pregnancy test.
- Threatened Abortion: If the cervix were not dilated and no tissue were visible, a threatened abortion could be considered. However, the presence of a dilated cervix and visible tissue makes this less likely.
Do Not Miss Diagnoses
- Ectopic Pregnancy with Rupture: This is a life-threatening condition that requires immediate attention. Even though the presence of tissue in the cervix suggests a miscarriage, a ruptured ectopic pregnancy must be considered, especially if the patient's condition deteriorates or if there are signs of hemodynamic instability.
- Molar Pregnancy: Although rare, a molar pregnancy can present with vaginal bleeding and a positive pregnancy test. It's crucial to consider this diagnosis to ensure appropriate management and to rule out potential complications.
Rare Diagnoses
- Cervical Pregnancy: This is an extremely rare condition where the embryo implants in the cervix. It can present with vaginal bleeding and a positive pregnancy test but is much less common than spontaneous abortion or ectopic pregnancy.
- Placenta Previa: Typically presents later in pregnancy, but if the patient has had a previous uterine surgery or pregnancy, it could be considered, although it's less likely given the early gestational age and symptoms.