Problem 7 A young woman with abnormal vaginal bleeding
A 32-year-old woman attends a general practice because she has had some irregular vaginal bleeding for the last 8 days. Her last normal menstrual period occurred 6 weeks ago. Her usual cycle length is between 4 and 6 weeks. She has been trying to conceive for the last 3 years, but has not managed to do so.
The results of the tests you arranged were as follows:
Investigation 7.1 Summary of results
| Haemoglobin | 42 g/L |
| White cell count | 8.5 × 109/L |
| Platelets | 160 × 109/L |
| Urinary pregnancy test | positive |
| Serum beta hCG | 1200 U/L |
| Cervical PAP smear | no abnormal cells detected; endocervical cells identified |
| Cervical swab | no evidence of chlamydial infection |
On the basis of the positive pregnancy test a pelvic ultrasound examination is arranged (Figure 7.1).
Answers
• Is she pregnant and does she have a pregnancy complication? In someone with cycles of variable length, pregnancy is possible so symptoms of pregnancy need to be sought. In someone who has had difficulty conceiving, when a pregnancy is achieved the chance of it being in an ectopic position is increased. You need to ask whether her last menstrual period was of normal volume and duration as it is not uncommon for a ‘period’ to occur in someone who has conceived although the amount of bleeding at the time of the ‘period’ is usually less than normally occurs. If she is pregnant the current 8 days of bleeding could be an indication of the pregnancy being in the Fallopian tube, and not the uterus (an ectopic pregnancy), or that one of the various forms of abortion are occurring (threatened, incomplete, complete or missed abortion).
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