Differential Diagnosis for Vaginal Spotting in a 9-Week Pregnant Woman
- Single Most Likely Diagnosis
- Threatened abortion: This is the most likely diagnosis given the patient's presentation of vaginal spotting with a closed cervin and no passage of tissue. The patient is at 9 weeks gestation, which is a common time for threatened abortion, and the absence of abdominal pain or cramping suggests that the pregnancy is likely still viable.
- Other Likely Diagnoses
- Cervical polyp or cervicitis: The patient's history of chlamydial cervicitis and the presence of minimal dark red discharge from the cervical os suggest that a cervical polyp or cervicitis could be causing the vaginal spotting.
- Implantation bleeding: Although the patient is already 9 weeks pregnant, it's possible that the spotting could be related to implantation of the embryo, especially if the patient's dates are off.
- Do Not Miss Diagnoses
- Placenta previa: Although less likely, placenta previa is a potentially life-threatening condition that must be considered in any pregnant patient with vaginal bleeding. The patient's lack of abdominal pain and the presence of a closed cervin make this diagnosis less likely, but it should still be ruled out with ultrasound imaging.
- Ectopic pregnancy: Although the patient has a positive urine pregnancy test and a palpable uterus, an ectopic pregnancy must be considered in any patient with vaginal bleeding and a positive pregnancy test. The patient's history of chlamydial cervicitis increases her risk for ectopic pregnancy.
- Rare Diagnoses
- Molar pregnancy: A molar pregnancy is a rare condition in which a non-viable fertilized egg implants in the uterus. The patient's presentation of vaginal spotting and a uterus that is larger than expected for her gestational age could suggest a molar pregnancy, but this diagnosis is relatively rare.
- Uterine anomaly or fibroid: A uterine anomaly or fibroid could cause vaginal spotting and a larger-than-expected uterus, but these conditions are relatively rare and would likely be associated with other symptoms or risk factors.