Differential Diagnosis for Vaginal Bleeding at 6 Weeks Gestation
- Single most likely diagnosis
- Cervical Ectropion or Cervical Polyp: The presence of a raised cervical mass that bleeds freely when manipulated, along with the absence of significant pelvic pain or other systemic symptoms, makes this diagnosis the most likely. The bleeding is likely related to the cervical lesion, especially given its tendency to bleed with minimal trauma, such as intercourse or manipulation during the exam.
- Other Likely diagnoses
- Threatened Abortion: Although the ultrasound shows a viable intrauterine pregnancy, the presence of vaginal bleeding at 6 weeks gestation could still suggest a threatened abortion. The fact that there's no pelvic pain and the cervix is closed somewhat reduces the likelihood but doesn't rule it out entirely.
- Cervicitis: Inflammation of the cervix could cause bleeding, especially after intercourse. However, the presence of a distinct cervical mass and the absence of other symptoms like discharge or itching make this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Ectopic Pregnancy: Although the ultrasound shows an intrauterine pregnancy, it's crucial to consider ectopic pregnancy in any case of first-trimester bleeding, especially if there's any doubt about the pregnancy's location or viability. The absence of pelvic pain and the presence of a viable intrauterine pregnancy on ultrasound make this less likely, but it's a diagnosis that must be considered due to its potential severity.
- Molar Pregnancy: While less common, a molar pregnancy could present with vaginal bleeding in the first trimester. The ultrasound finding of a yolk sac and fetal pole makes this less likely, but it should be considered, especially if there are any abnormalities in the uterine size or the presence of excessive uterine bleeding.
- Rare diagnoses
- Cervical Cancer: Although extremely rare in this context, especially without other symptoms or risk factors, cervical cancer could present with abnormal vaginal bleeding and a cervical mass. The patient's age and the acute presentation make this less likely, but it's a consideration in the differential diagnosis, especially if other causes are ruled out.
- Choriocarcinoma: This is a rare malignancy that could occur in the setting of a pregnancy and present with vaginal bleeding. It's much less common than other diagnoses listed here and would typically be associated with more systemic symptoms or a history of a molar pregnancy, abortion, or ectopic pregnancy.