Unexpected complications

Mysterious bleeding causes fear and uncertainty for a woman who finds out she is pregnant

Jenny, 23, presents to her GP with a recent history of irregular vaginal bleeding.

Although previously regular, her periods simply ceased three months ago. Jenny has started bleeding just prior to arriving for her consultation.

On questioning, Jenny says she feels “off-colour”.

On physical examination, her abdomen is soft; bimanual pelvic assessment reveals an enlarged uterus (of about 10-12-weeks’ gestation size), with tenderness and suggestion of a mass in the left adnexa. A small smear of blood is noted at the external os; the opportunity is taken to collect a Pap smear. A urine