Seen in the ED Quiz: 6 Weeks Pregnant with Vaginal Bleeding

The patient is 42-years-old, G2P1 and presents with 1 week of vaginal spotting, 4 days of pelvic pain. Review the ultrasound and lab findings. What's your diagnosis?

Patient history. A 42-year-old woman who is G2P1 and approximately 6 weeks pregnant is sent from her clinic to the emergency department for 1 week of vaginal spotting and 4 days of pelvic pain. She denies any fever, dysuria, vomiting, or other complaints.

Normal hCG levels (mIU/mL) by week:

4 weeks: 5 – 426

5 weeks: 18 – 7340

6 weeks: 1080 – 56 500

7–8 weeks: 7650 – 229 000

9–12 weeks: 25 700 – 288 000 (PEAK)

13–16 weeks: 13 300 – 254 000

Exam. Vital signs all are normal. Exam is normal except for mild suprapubic tenderness.

Initial Concerns:

  • Ectopic pregnancy
  • Threatened abortion
  • UTI
  • Sexually transmitted disease

Testing:

  • CBC: normal
  • Beta hCG: ~270,000 mIU/mL (see normal values, by week of gestation, at right)
  • Pelvic ultrasound: see image

What does the case image show?


Molar Pregnancy fromThe Emergency Medicine 1-Minute Consult Pocketbook