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Develop a differential diagnosis in a patient with first trimester bleeding

Learner Task: Review the following lab and radiology results and develop a differential diagnosis for first trimester bleeding.

  • Labs: WBC’s normal, Hemoglobin 10.1, Hematocrit 30%, platelets 225K, hCG 8326 mIU/ml, Blood type O Positive
  • Radiology: Ultrasound showed right sided adnexal mass containing a gestational sac measuring 0.9 cm with yolk sac measuring 0.4 mm. No fetal pole or heart beat. The entire adnexal mass measures 2.2 cm, with mild free fluid in pelvis; no intrauterine gestational sac seen. Normal left adnexa.

Educator Checklist: Differential Diagnosis of First Trimester Bleeding
Mark the appropriate column to indicate whether the learner included each element in his or her response. When completed, tally the “Included” column to calculate the learner’s score.

Included =1 Not included =0
Intrauterine pregnancy
Ectopic pregnancy
Spontaneous abortion (missed, threatened, incomplete, complete, septic)
Bleeding from lower urogenital tract (i.e. cervix, vagina)
Molar pregnancy
Bleeding from rectum

Learner Follow-up: Based on the information so far, what is the diagnosis?
Correct Answer: Unruptured ectopic pregnancy