Clinical Presentation A 39-year-old, gravida 2, para 2 woman presented to the gynecological clinic for a routine examination. History No significant medical history. Uncomplicated vaginal delivery of a term infant, six months ago. History of present illness Now the patient complains of persistent vaginal bleeding over a month with mild vague abdominal pain and a cough that recently started. She requires at least 1 pad every day. Physical Examination Vital signs: Normal range.
Lungs: clear bilaterally; no wheezes, rales, or rhonchi. External genitalia: appearance is normal, perineum intact. Pelvic exam: a small, friable mass is observed 2 cm from the cervix on the anterior vaginal wall. Cervix: appears parous and slightly dilated, with blood-tinged discharge observed at the external os. Bimanual exam: bilateral adnexal fullness and a 14-week size uterus. What is the most likely…
