Differential Diagnosis for Vaginal Spotting and Discharge in a Pregnant Woman
- Single most likely diagnosis:
- Threatened abortion: This is the most likely diagnosis given the patient's symptoms of vaginal spotting and discharge, positive pregnancy test, and ultrasound showing an intrauterine fetal pole with a positive fetal heartbeat. The presence of bloody, yellow mucus at the external cervical os also supports this diagnosis. Threatened abortion is characterized by vaginal bleeding or spotting in the first 20 weeks of pregnancy, with the cervix remaining closed.
- Other Likely diagnoses:
- Inevitable abortion: Although the patient's cervix is currently closed, the presence of vaginal spotting and discharge could potentially progress to inevitable abortion if the cervix dilates and bleeding increases.
- Cervicitis: The patient's symptoms of increased vaginal discharge and bloody, yellow mucus at the external cervical os could be indicative of cervicitis, an inflammation of the cervix.
- Pregnancy-related physiological discharge: The patient's increased vaginal discharge could be a normal physiological response to pregnancy, as hormonal changes can cause increased cervical mucus production.
- Do Not Miss diagnoses:
- Ectopic pregnancy: Although the ultrasound shows an intrauterine fetal pole, it is essential to consider ectopic pregnancy, especially if the patient's symptoms worsen or if the quantitative β-hCG level does not correlate with the expected gestational age.
- Molar pregnancy: This rare condition can cause vaginal bleeding and discharge, and it is crucial to rule out molar pregnancy, especially if the patient's symptoms persist or worsen.
- Placenta previa: Although less likely at 5 weeks gestation, placenta previa can cause vaginal bleeding and should be considered if the patient's symptoms worsen or if the ultrasound findings are suspicious.
- Rare diagnoses:
- Gestational trophoblastic disease: This rare condition can cause vaginal bleeding and discharge, and it is essential to consider it in the differential diagnosis, especially if the patient's symptoms persist or worsen.
- Uterine anomalies: Congenital uterine anomalies, such as a septate uterus, can increase the risk of miscarriage and vaginal bleeding, and should be considered in the differential diagnosis if the patient's symptoms persist or worsen.