Differentials
Ectopic pregnancy/heterotopic pregnancy
SIGNS / SYMPTOMS
Atypical symptoms that can be missed include iliac fossa or suprapubic pain, unexplained pallor, tachycardia, or syncope.
Positive findings on examination are adnexal tenderness or suggestion of haemoperitoneum.
An early intra-uterine pregnancy may co-exist with an ectopic pregnancy.
INVESTIGATIONS
Trans-vaginal ultrasound scan is diagnostic, depending on the site of the extra-uterine pregnancy and the index of suspicion.
Serial measurements of serum beta hCG and a single measure of progesterone may help distinguish between early viable, poor prognosis or ectopic gestation.[82]
Scan reveals an empty uterine cavity, a complex or cystic adnexal mass with or without free fluid in the pouch of Douglas.
If in doubt, laparoscopy can confirm the diagnosis and will show a distended, ruptured, or haemorrhagic fallopian tube, or other extrauterine pregnancy site.
Hydatidiform mole
SIGNS / SYMPTOMS
Uterine size is much larger than expected for gestational age.
Pregnancy symptoms are marked.
Very rarely, the patient might have passed some molar, grape-like tissue.
INVESTIGATIONS
Trans-vaginal ultrasound may reveal the classic snow storm appearance.
Partial hydatidiform mole
SIGNS / SYMPTOMS
Uterine size is much larger than expected for gestational age.
Pregnancy symptoms are marked.
INVESTIGATIONS
Ultrasound may reveal a fetus, with an extensive but unusual-looking placenta.
Cystitis
SIGNS / SYMPTOMS
Suprapubic pain with dysuria and fever.
Some patients present with haematuria.
INVESTIGATIONS
Urine microscopy and culture confirms the possible diagnosis.
Pregnancy co-existing with a bleeding cervical polyp/large ectropion
SIGNS / SYMPTOMS
May be suspected from appearances of the ecto-cervix on speculum examination.
INVESTIGATIONS
Confirmed after an ultrasound scan, or by spontaneous avulsion of the polyp.
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