History of Present Illness (HPI)

The patient is a 25-year-old female who is 5 weeks pregnant, presenting with spotting blood, slight cramping, and constipation. She reports a small amount of blood when wiping after urinating and experiencing harder than usual bowel movements. She has not had a prenatal check-up yet.

Differential Diagnosis

• Single Most Likely Diagnosis
  • Threatened Abortion: This is the most likely diagnosis given the patient's symptoms of spotting and cramping in early pregnancy. The presence of a small amount of blood and slight cramping are common symptoms of a threatened abortion.
• Other Likely Diagnoses
  • Constipation: The patient's report of constipation and harder than usual bowel movements could be contributing to her symptoms, including spotting and cramping.
  • Urinary Tract Infection (UTI): The patient's symptoms of blood when wiping after urinating could be indicative of a UTI, which is common during pregnancy.
  • Hemorrhoids: The patient's report of constipation and harder than usual bowel movements could be contributing to the development of hemorrhoids, which could cause spotting.
• Do Not Miss Diagnoses
  • Ectopic Pregnancy: Although less likely, an ectopic pregnancy is a life-threatening condition that must be ruled out in any pregnant patient presenting with abdominal pain and vaginal bleeding.
  • Placenta Previa: This condition, where the placenta covers the cervix, can cause vaginal bleeding and is a serious condition that requires prompt diagnosis and treatment.
  • Miscarriage: A miscarriage is a possible diagnosis, and although it may not be immediately life-threatening, it requires prompt evaluation and management.
• Rare Diagnoses
  • Molar Pregnancy: A rare condition where a non-viable fertilized egg implants in the uterus, causing symptoms such as vaginal bleeding and abdominal pain.
  • Ovarian Torsion: A rare condition where the ovary twists, cutting off its blood supply, which can cause severe abdominal pain and vaginal bleeding.