Differential Diagnosis for Vaginal Bleeding in a 39-year-old Primigravid Woman at 7 Weeks Gestation
- Single most likely diagnosis
- Threatened abortion: This is the most likely diagnosis given the patient's symptoms of vaginal bleeding, mild uterine cramping, and the presence of a closed cervix on pelvic examination. The pelvic ultrasound would be crucial in confirming the presence of an intrauterine pregnancy, which, combined with the patient's symptoms, supports this diagnosis.
- Other Likely diagnoses
- Missed abortion: Although less likely than a threatened abortion if the ultrasound shows a viable pregnancy, a missed abortion could be considered if the ultrasound indicates a non-viable pregnancy without evidence of expulsion.
- Ectopic pregnancy: While the presence of an intrauterine pregnancy on ultrasound would make this less likely, it's still a consideration, especially if the ultrasound is not definitive or if there are concerns about a heterotopic pregnancy (though very rare, especially in natural conceptions).
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ectopic pregnancy: Even though mentioned under other likely diagnoses, it's crucial to emphasize its inclusion here due to its potential for severe morbidity and mortality if missed.
- Molar pregnancy: Although rare, a molar pregnancy can present with vaginal bleeding and should be considered, especially if the ultrasound shows characteristics suggestive of a molar pregnancy.
- Placenta previa: Though typically presents later in pregnancy, it's a condition that could lead to significant bleeding and should be considered, especially if the ultrasound suggests placental abnormalities.
- Rare diagnoses
- Heterotopic pregnancy: This is a rare condition where there is both an intrauterine and an ectopic pregnancy, more commonly seen in pregnancies achieved through assisted reproductive technology.
- Cervical polyp or other cervical pathology: Though not directly related to the pregnancy itself, these conditions could cause vaginal bleeding and should be considered if other causes are ruled out.