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

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.

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