A 24 year-old woman G2P1, with one prior healthy vaginal delivery and no significant medical conditions presents to the emergency department with complaints of abnormal vaginal bleeding and severe nausea and vomiting at 10 weeks of gestation. She describes her bleeding as intermittent but heavy at times and notes that her nausea is much worse than in her first pregnancy. On examination, her uterus is larger than expected for 10 weeks gestation. She denies abdominal pain or fever. There are no signs of hemodynamic instability. Laboratory tests are ordered. Beta-hCG is markedly elevated at 150,000 IU/L, significantly higher than expected for her gestational age. The ultrasound reveals a “snowstorm” pattern consistent with a complete molar pregnancy. She is diagnosed with a complete molar pregnancy. After counseling, she undergoes suction curettage to evacuate the uterus. What is the most important follow-up measure after evacuation of a complete molar pregnancy?

A 25-year-old woman presents to the clinic complaining of vaginal bleeding and abdominal pain. She reports missing her last menstrual period and experiencing nausea and vomiting. On physical examination, the uterus is enlarged for gestational age. A pelvic ultrasound is performed, revealing a heterogeneous, complex mass within the uterine cavity. It reveals no fetal parts. Laboratory tests confirm elevated levels of human chorionic gonadotropin (hCG). You suspect a complete molar pregnancy. Which of the following is NOT a typical feature of a complete molar pregnancy?

A 24 year-old woman G2P1, with one prior healthy vaginal delivery and no significant medical conditions presents to the emergency department with complaints of abnormal vaginal bleeding and severe nausea and vomiting at 10 weeks of gestation. She describes her bleeding as intermittent but heavy at times and notes that her nausea is much worse than in her first pregnancy. On examination, her uterus is larger than expected for 10 weeks gestation. She denies abdominal pain or fever. There are no signs of hemodynamic instability. Laboratory tests are ordered. Beta-hCG is markedly elevated at 150,000 IU/L, significantly higher than expected for her gestational age. You suspect a complete molar pregnancy. What is the hallmark ultrasound finding in a complete molar pregnancy?

A 34-year-old woman presents to the emergency department with a sudden onset of dizziness and lower abdominal pain, specifically on the right side, which started 12 hours prior to her visit. The pain has progressively worsened, radiating to her shoulder, and is accompanied by light vaginal bleeding. She notes that her last menstrual period was 7 weeks before this episode. Her medical history included a treated case of pelvic inflammatory disease, a prior tubal surgery, a prior ectopic pregnancy, and prior IUD use. She smokes more than 20 cigarettes per day and drinks 2 or 3 alcoholic beverages. Upon examination, her vital signs showed a blood pressure of 90/60 mmHg, a heart rate of 104 bpm, respiratory rate of 18 breaths per minute, and a temperature of 37.2°C. The abdominal examination reveals tenderness in the right lower quadrant with rebound tenderness and guarding. A pelvic exam confirms right adnexal tenderness with minimal blood in the vaginal vault. In this visit, which of the following is the most significant risk factor for ectopic pregnancy in this patient?

A 32-year-old woman presents to the emergency department with a sudden onset of dizziness and lower abdominal pain, specifically on the right side, which started 12 hours prior to her visit. The pain has progressively worsened, radiating to her shoulder, and is accompanied by light vaginal bleeding. She notes that her last menstrual period was 7 weeks before this episode. Her medical history included a treated case of pelvic inflammatory disease and mild endometriosis, with one previous normal vaginal delivery three years ago. Upon examination, her vital signs showed a blood pressure of 90/60 mmHg, a heart rate of 104 bpm, respiratory rate of 18 breaths per minute, and a temperature of 37.2°C. The abdominal examination reveals tenderness in the right lower quadrant with rebound tenderness and guarding. A pelvic exam confirms right adnexal tenderness with minimal blood in the vaginal vault. What is the next step in the management of this patient?

A 24-year-old woman presents to the emergency department with complaints of lower abdominal pain and vaginal spotting for the past three days. She describes the pain as sharp and intermittent, primarily on the right side, and denies any fever or chills. She reports a positive home pregnancy test taken two weeks ago but has not yet seen a healthcare provider. Her last menstrual period was six weeks ago. She denies significant medical history, prior surgeries, or sexually transmitted infections but mentions occasional irregular menstrual cycles. On physical examination, the patient appears mildly distressed due to pain. Her vital signs reveal a blood pressure of 110/70 mmHg, a pulse of 95 beats per minute, and no fever. Abdominal examination shows tenderness in the right lower quadrant without guarding or rebound tenderness. Pelvic examination reveals mild cervical motion tenderness and tenderness in the right adnexa, with no palpable masses. Speculum examination shows a small amount of dark blood in the vaginal vault. A urine pregnancy test performed in the emergency department is positive.You suspect ectopic pregnancy. Which of the following is a contraindication for methotrexate treatment in ectopic pregnancy?

A 28-year-old woman presents to the emergency department with complaints of lower abdominal pain and vaginal spotting for the past three days. She describes the pain as sharp and intermittent, primarily on the right side, and denies any fever or chills. She reports a positive home pregnancy test taken two weeks ago but has not yet seen a healthcare provider. Her last menstrual period was six weeks ago. She denies significant medical history, prior surgeries, or sexually transmitted infections but mentions occasional irregular menstrual cycles. On physical examination, the patient appears mildly distressed due to pain. Her vital signs reveal a blood pressure of 110/70 mmHg, a pulse of 95 beats per minute, and no fever. Abdominal examination shows tenderness in the right lower quadrant without guarding or rebound tenderness. Pelvic examination reveals mild cervical motion tenderness and tenderness in the right adnexa, with no palpable masses. Speculum examination shows a small amount of dark blood in the vaginal vault. A urine pregnancy test performed in the emergency department is positive.You suspect ectopic pregnancy. Which of the following is the best initial diagnostic step for suspected ectopic pregnancy?

A 30-year-old woman presents to the emergency department complaining of severe lower abdominal pain, vaginal bleeding, and nausea. She reports her last menstrual period was 6 weeks ago and she has experienced mild cramping and spotting. A pelvic examination reveals tenderness in the adnexa. A pregnancy test is positive. A transvaginal ultrasound is performed, which shows a non-viable intrauterine pregnancy and a complex adnexal mass, suggestive of an ectopic pregnancy. What is the most common site for an ectopic pregnancy?

Emily, a 25-year-old graphic designer, visited her gynecologist complaining of unusual vaginal discharge, mild lower abdominal pain, and discomfort during urination. These symptoms had persisted for about a week. Emily mentioned she was sexually active with a new partner for the past month, and although they used condoms inconsistently, she had not experienced such symptoms before. On examination, her vital signs were stable. The physical exam revealed a moderate amount of yellow-green discharge with a slightly fishy odor, and her cervix appeared erythematous. There was tenderness upon palpation of the lower abdomen, but no rebound tenderness. The preliminary wet mount revealed motile trichomonads, confirming a diagnosis of trichomoniasis, which is often sexually transmitted and can cause the symptoms Emily was experiencing. Sexually transmitted infections increase the risk of which of the following medical conditions in Emily?

A 28-year-old woman, pregnant with her second child, presented to her obstetrician-gynecologist with a history of recurrent second-trimester pregnancy losses. Her first pregnancy had ended in a preterm delivery at 24 weeks gestation. A physical examination revealed a short cervix. A cervical length ultrasound was performed, confirming cervical shortening. A diagnosis of cervical insufficiency, or cervical incompetence, was made. The patient was placed on bed rest and prescribed vaginal progesterone suppositories. In addition, a cerclage procedure was performed to help maintain the pregnancy. What is the primary purpose of cervical cerclage in the management of cervical incompetence?