A 39-year-old, G2P2 female presents to the clinic for a routine gynecologic examination. She has no significant medical history. Six months ago, she had an uncomplicated vaginal delivery of a term infant.
Presently, the patient complains of persistent vaginal bleeding over the past month, mild vague abdominal pain that she relates to gas, and a cough that recently started. Her bleeding requires at least 1 pad every day. Physical Examination Vital signs: all within normal limits Lungs: clear to auscultation bilaterally; no wheezes, rales, or rhonchi External genitalia: appearance is normal, perineum intact Pelvic exam: a small, friable mass is discovered 2 cm from the cervix on the anterior vaginal wall Cervix: appears parous and slightly dilated, with blood-tinged discharge present at the external os Bimanual exam: bilateral adnexal fullness and a 14-week size uterus Work Up A…
