Question

A 28-year-old G0 woman whose last normal menstrual period was four weeks ago presents with a two-day history of spotting. She awoke this morning with left lower quadrant pain of intensity 4/10. She has no urinary complaints, no nausea or vomiting, and the remainder of the review of systems is negative. She has no history of sexually transmitted infections. She smokes one pack of cigarettes per day and denies alcohol or drug use. Her vital signs are: blood pressure 124/68, pulse 76, respirations 18, and temperature 100.2° F (37.9°C). On examination, she has mild left lower quadrant tenderness, with no rebound or guarding. Pelvic exam is normal except for mild tenderness on the left side. Quantitative Beta-hCG is 400 mIU/ml; progesterone 5 ng/ml; hematocrit 34%. Ultrasound shows a fluid collection in the uterus, with no adnexal masses and no free fluid. What is the most likely diagnosis?

A. Ovarian torsion
B. Missed abortion
C. Early intrauterine pregnancy
D. Unable to establish a diagnosis
E. Ectopic pregnancy

Answer 1

The most likely diagnosis for the presented symptoms is an Early intrauterine pregnancy, considering the Beta-hCG levels, absence of adnexal masses, and the presence of a fluid collection in the uterus. Other serious conditions are less likely based on the information provided.

Step-by-step explanation:

The most likely diagnosis for a 28-year-old G0 woman presenting with a two-day history of spotting, left lower quadrant pain, no history of sexually transmitted infections, and being a smoker is C.

Early intrauterine pregnancy. The presence of spotting could indicate implantation bleeding, and the mild tenderness on pelvic exam could be due to changes occurring in early pregnancy.

The Beta-hCG level is appropriate for a very early pregnancy, and the ultrasound findings of a fluid collection in the uterus without adnexal masses or free fluid can suggest an early gestational sac or implantation fluid. The other options such as ovarian torsion, missed abortion, and ectopic pregnancy are less likely given the clinical and ultrasound findings, and more information would be needed to establish one of those diagnoses with confidence.