A 35-year-old G9 P6026 at 8 weeks' gestation presents to the hospital with vaginal spotting associated with very mild lower abdominal pain. She has noticed some dark brown clots. E... A 35-year-old G9 P6026 at 8 weeks' gestation presents to the hospital with vaginal spotting associated with very mild lower abdominal pain. She has noticed some dark brown clots. Examination reveals she is comfortable in bed with no abdominal tenderness appreciated. Pelvic examination reveals minimal dark-red clots in the introitus and cervical os closed (see report). Transvaginal ultrasound: 5-week gestational size with no fetal heart. Which of the following is the most appropriate next step of management plan?
Understand the Problem
The question describes a patient presenting with symptoms suggestive of a possible miscarriage. We need to determine the most appropriate next step in management based on the information provided (patient history, examination findings, and ultrasound results). The key is to assess the pregnancy viability and then select the appropriate course of action, such as surgical intervention, medical management, or expectant management.
Answer
Repeat transvaginal ultrasound in 1 week to reassess fetal viability.
Given the patient's presentation (vaginal spotting, mild pain, closed cervical os, and ultrasound findings of a 5-week gestational size without a fetal heartbeat at 8 weeks gestation), the most appropriate next step is to repeat the transvaginal ultrasound in 1 week to reassess fetal viability. This allows time to see if there is any change or progression before making a definitive diagnosis of pregnancy failure.
Answer for screen readers
Given the patient's presentation (vaginal spotting, mild pain, closed cervical os, and ultrasound findings of a 5-week gestational size without a fetal heartbeat at 8 weeks gestation), the most appropriate next step is to repeat the transvaginal ultrasound in 1 week to reassess fetal viability. This allows time to see if there is any change or progression before making a definitive diagnosis of pregnancy failure.
More Information
In early pregnancy, it can be difficult to immediately determine if a pregnancy is nonviable based on a single ultrasound. Repeating the ultrasound allows for a more accurate assessment of fetal development over time. In addition, the association of dark brown clots, which can occur when blood clots after a few days of heavier flow.
Tips
A common mistake is to immediately assume a nonviable pregnancy and proceed with medical or surgical management without allowing time for reassessment.
Sources
- Pelvic Pain and Vaginal Bleeding - M3 Curriculum - SAEM - saem.org
- Signs & symptoms - The Miscarriage Association - miscarriageassociation.org.uk
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