A 34-Year-Old Woman Comes to the Emergency Department for Vaginal

question 203

Multiple Choice

A 34-year-old woman comes to the emergency department for vaginal bleeding.  The patient initially had vaginal spotting yesterday, but the bleeding has become increasingly heavy.  She also has had lower abdominal pain with nausea for the past hour.  Her last menstrual period was 7 weeks ago.  She is sexually active and does not use contraception due to a history of infertility.  The patient has had no surgeries and takes no daily medications.
Blood pressure is 100/50 mm Hg and pulse is 92/min.  BMI is 41 kg/m².  The abdomen is tender in bilateral lower quadrants with involuntary guarding.  Pelvic examination reveals a closed cervix with active bleeding from the cervical os.  Bimanual examination reveals a small, mobile uterus and right adnexal tenderness.
Hemoglobin is 9.8 g/dL and quantitative β-hCG is 7,135 IU/L.  Transvaginal ultrasound shows a thickened endometrial stripe, a 4-cm complex right adnexal mass, and a small amount of free fluid in the posterior cul-de-sac.
Which of the following is the most likely diagnosis in this patient?

• A)Abruptio placentae
• B)Complete hydatidiform mole
• C)Ectopic pregnancy
• D)Incomplete abortion
• E)Pelvic endometriosis

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