Early pregnancy loss Quiz: Ace Your Exams

A 29-year-old woman, gravida 2, para 1, at 7 weeks 3 days of gestation by last menstrual period (LMP) comes to the emergency department with a three-day history of intermittent vaginal bleeding and worsening pelvic and low back pain. Past medical history is notable for polycystic ovary syndrome with irregular menstrual cycles, ranging from 25 to 45 days in length, and her only medication is a prenatal vitamin. The patient’s previous pregnancy was uncomplicated and resulted in a vaginal delivery at term. Temperature is 37.3°C (99.1°F), pulse is 82/min, respirations are 16/min, and blood pressure is 110/72 mmHg. On exam, a small trickle of dark blood is coming from a closed external cervical os, and there is no significant uterine tenderness. A urine human chorionic gonadotropin (hCG) is positive. The ultrasound shows an intrauterine gestational sac with a fetal pole measuring 6 mm from crown to rump without evidence of cardiac activity. Which of the following is the most appropriate next step in management?