A 36-year-old woman presents with vaginal bleeding at 8 weeks 3 days gestation. She has never been pregnant before. Bright red spotting commenced 7 days ago, which she thought was normal in early pregnancy. However, since then the bleeding is now almost as heavy as a period. There are no clots. She has abdominal pain.
Systemically she has felt nausea for 3 weeks and has vomited occasionally. She had a large- loop excision of the transformation zone (LLETZ) tretamne5 after an abnormal smear 6 years ago. Since then all smears have been normal. There is no other significant gynecological history. She has regular periods of bleeding for 5 days every 28 days and has never had any known sexually transmitted infections in the past she used condoms for contraception. Physical examination: HR- 68/min BP- 108/70mmhg Abdomen- soft and non-tender Speculum reveals a normally closed cervix with a…
