Differential Diagnosis for a 32-year-old woman with severe lower abdominal pain and heavy vaginal bleeding at 11 weeks gestation
- Single most likely diagnosis
- Ectopic Pregnancy: Given the patient's presentation of severe lower abdominal pain, heavy vaginal bleeding, and an empty uterus on ultrasonography, ectopic pregnancy is the most likely diagnosis. The presence of a dilated cervix and active bleeding further supports this diagnosis, as it suggests that the pregnancy is not viable in the uterus and has likely implanted elsewhere, such as the fallopian tube.
- Other Likely diagnoses
- Spontaneous Abortion: Although the ultrasonography shows an empty uterus, spontaneous abortion (miscarriage) could still be considered, especially if the patient has passed tissue-like material. However, the severity of symptoms and the presence of an empty uterus make ectopic pregnancy more likely.
- Molar Pregnancy: This condition, characterized by abnormal trophoblastic proliferation, can cause severe bleeding and abdominal pain. However, it typically presents with a uterus larger than expected for gestational age and specific ultrasonographic findings, which are not mentioned in the scenario.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ruptured Ovarian Cyst: Although less likely given the patient's pregnancy, a ruptured ovarian cyst can cause severe abdominal pain and bleeding. It's crucial to consider this diagnosis due to its potential for severe consequences if missed.
- Placenta Previa: This condition, where the placenta covers the cervical os, can cause severe vaginal bleeding. However, it typically presents later in pregnancy and is less likely at 11 weeks gestation.
- Rare diagnoses
- Heterotopic Pregnancy: This is a rare condition where there are simultaneous intrauterine and ectopic pregnancies. Given the patient's history of previous pregnancies and the presence of an empty uterus, this diagnosis is possible but less likely.
- Uterine Rupture: Although extremely rare in the absence of previous uterine surgery or trauma, uterine rupture can cause severe abdominal pain and bleeding. It is essential to consider this diagnosis due to its high morbidity and mortality if missed.