Differential Diagnosis for Vaginal Bleeding and Severe Pelvic Cramping at 7 Weeks Pregnancy
Single Most Likely Diagnosis
- Ectopic Pregnancy: This is the most likely diagnosis given the symptoms of vaginal bleeding, severe pelvic cramping, dropping quantitative hCG levels, and the inability to locate the pregnancy via transvaginal ultrasound. Ectopic pregnancy occurs when the embryo implants outside the uterus, often in the fallopian tube, and is a life-threatening condition if not promptly diagnosed and treated.
Other Likely Diagnoses
- Spontaneous Abortion (Miscarriage): The symptoms of vaginal bleeding and pelvic cramping, along with dropping hCG levels, could also indicate a miscarriage. However, the inability to locate the pregnancy on ultrasound makes ectopic pregnancy more likely.
- Failed Pregnancy with Retained Products of Conception: This condition involves a non-viable pregnancy that has not been fully expelled from the uterus, which could cause bleeding and cramping.
Do Not Miss Diagnoses
- Ruptured Ectopic Pregnancy: Although included in the broader category of ectopic pregnancy, a ruptured ectopic pregnancy is an emergency that requires immediate surgical intervention. It presents with severe, sudden-onset abdominal pain and can lead to hemodynamic instability.
- Ovarian Torsion: Although less common, ovarian torsion can present with severe pelvic pain and could be associated with vaginal bleeding if there is concomitant ovarian cyst rupture. It is a surgical emergency.
- Hemorrhagic Ovarian Cyst: A ruptured ovarian cyst can cause severe pelvic pain and vaginal bleeding. While not typically associated with pregnancy, it could be considered in the differential due to the severity of symptoms.
Rare Diagnoses
- Heterotopic Pregnancy: This is a rare condition where there are simultaneous intrauterine and ectopic pregnancies. It is more common in women undergoing fertility treatments but is still a rare occurrence.
- Molar Pregnancy with Ectopic Component: Although extremely rare, a molar pregnancy (abnormal proliferation of trophoblastic tissue) can very rarely have an ectopic component, presenting with similar symptoms.