Differential Diagnosis
- Single most likely diagnosis
- Placenta previa: This condition is characterized by the placenta covering or lying close to the internal cervical os, which can cause vaginal bleeding in the second or third trimester. The patient's symptoms of vaginal spotting, increased vaginal discharge, and pelvic pressure, along with the ultrasound finding of a low-lying anterior placenta, support this diagnosis.
- Other Likely diagnoses
- Preterm labor: The patient's symptoms of pelvic pressure and cervical dilation to 2 cm may indicate preterm labor, especially given her history of chronic hypertension and type 2 diabetes mellitus.
- Cervical insufficiency: The patient's history of a cone biopsy and the presence of a visibly dilated cervix with smooth, shiny membranes bulging through the os may suggest cervical insufficiency.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Placental abruption: Although the patient does not have significant bleeding or abdominal pain, placental abruption is a life-threatening condition that requires prompt diagnosis and treatment.
- Uterine rupture: Given the patient's history of a cone biopsy, there is a small risk of uterine rupture, which is a medical emergency.
- Preeclampsia: Although the patient's blood pressure is currently well-controlled, her history of chronic hypertension and type 2 diabetes mellitus increases her risk for preeclampsia, which can be a life-threatening condition.
- Rare diagnoses
- Vasa previa: This condition occurs when fetal blood vessels are present in the membranes covering the cervix, which can cause significant bleeding if ruptured.
- Cervical cancer: Although the patient has a history of an abnormal Pap test and cone biopsy, the current symptoms are more likely related to her pregnancy rather than a new or recurrent cervical cancer.