Approach to first trimester bleeding Quiz: Ace Your Exams

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A 32-year-old woman, G3P2, presents to the clinic with vaginal bleeding. The bleeding started as light, intermittent spotting four weeks ago, but eight hours ago, it became much heavier. It is not associated with abdominal or pelvic pain. Her last menstrual period was 10 weeks ago, and a home pregnancy test confirmed that she is pregnant. She initially disregarded the bleeding because she had similar, light bleeding with her previous pregnancies. Both previous pregnancies resulted in the birth of healthy, full-term babies. She reports nausea and vomiting that is more severe than what she experienced with her previous pregnancies. Past medical and surgical histories are unremarkable. Vital signs are within normal limits. Abdominal examination is unremarkable. No fetal heart tones are detected. Pelvic examination reveals a 12 cm, non-tender uterus, and bilateral 5 cm smooth adnexal masses. Which of the following ultrasound findings would be consistent with the most likely diagnosis?

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Endometrial lining < 15 mm

Gestational sac > 25 mm and no fetal cardiac activity

Thickened heterogeneous endometrium with mixed echogenic material

Empty extrauterine sac with a hyperechoic ring

Complex, heterogeneous intrauterine mass containing multiple small cysts