Differential diagnosis

1. Benign and malignant lesions. The cervix often bleeds from an ectropion of friable tissue. Hemostasis can be accomplished by applying pressure for several minutes with a large swab or by cautery with a silver nitrate stick. Atypical cervical lesions are evaluated with colposcopy and biopsy. 2. Disorders of pregnancy a. Hydatidiform mole may present with early pregnancy bleeding, passage of grape-like vesicles, and a uterus that is enlarged in excess of that expected from dates. An absence of heart tones by Doppler after 12 weeks is characteristic. Hyperemesis, preeclampsia, or hyperthyroidism may be present. Ultrasonography confirms the diagnosis.

b. Ectopic pregnancy should be excluded when first trimester bleeding is associated with pelvic pain. Orthostatic light-headedness, syncope or shoulder pain (from diaphragmatic irritation) may occur.

(1) Abdominal tenderness is noted, and pelvic examination reveals cervical motion tenderness.

(2) Serum beta-HCG is positive.

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