A 24-year-old cashier comes to your clinic for her first OB visit. She had her last period 10 weeks before, which would mean she is 12 weeks pregnant. She did a home pregnancy urine test a month ago and it was positive. She has had some fatigue and nausea, but not in the last week. She has had no cramping or bleeding. Her vital signs, head, eyes, ears, nose, throat, thyroid, cardiac, pulmonary, and abdominal examinations are all unremarkable. On speculum examination her os is closed and there is a pinkish hue to the cervix. On bimanual examination the cervix is soft and the uterus is enlarged to the pelvic brim. Despite 20 minutes of trying, you cannot find heart tones. You repeat a urine pregnancy test and it is negative. A serum pregnancy test is ordered and is positive. You send the patient for a vaginal ultrasound. What is the most likely explanation for her presentation?

Question

Quizplus · Accepted Answer

This patient has lost some of the symptoms of pregnancy, including fatigue and nausea. Also, there are no fetal heart tones despite the 12-week uterus. A negative urine test indicated decreasing levels of beta HCG of pregnancy, although there is still enough to pick up on the more sensitive serum test.

A 24-Year-Old Cashier Comes to Your Clinic for Her First