Differential Diagnosis for the Patient's Miscarriage
- Single Most Likely Diagnosis
- Ectopic Pregnancy: The patient's presentation with vaginal bleeding, cramping, and an empty uterus on ultrasound, along with a low β-hCG level, makes ectopic pregnancy the most likely diagnosis. The history of prior dilation and curettage procedures also increases the risk of ectopic pregnancy.
- Other Likely Diagnoses
- Spontaneous Abortion: Given the patient's history of two prior early first-trimester losses, spontaneous abortion is a possible cause of her current symptoms. However, the empty uterus and low β-hCG level make this less likely.
- Molar Pregnancy: Although less common, a molar pregnancy could present with vaginal bleeding and an empty uterus. However, the presence of a single subserosal fibroid and the patient's symptoms make this less likely.
- Do Not Miss Diagnoses
- Pulmonary Embolism: The patient's history of sudden right arm weakness and slurred speech, which resolved spontaneously, could be a sign of a previous transient ischemic attack (TIA). This, combined with her high BMI and potential for increased coagulability during pregnancy, makes pulmonary embolism a diagnosis that should not be missed.
- Stroke: The patient's previous episode of sudden right arm weakness and slurred speech could be a sign of a previous stroke. Although the patient's symptoms resolved, it is essential to consider this diagnosis due to its potential impact on her health and pregnancy.
- Rare Diagnoses
- Gestational Trophoblastic Disease: This rare condition could present with vaginal bleeding and an empty uterus. However, the patient's symptoms and ultrasound findings make this a less likely diagnosis.
- Uterine Rupture: Although rare, uterine rupture could occur in a patient with a history of prior uterine surgery, such as dilation and curettage procedures. However, the patient's symptoms and ultrasound findings do not strongly support this diagnosis.