Picture Quiz: Vaginal bleeding and vommiting in early pregnancy
A 45 year old woman was in the 14th week of her second pregnancy. Fourteen years ago she gave birth to a normal baby at term. She now complained of heavy vaginal bleeding to her general practitioner. She missed her ultrasound scan at 12 weeks because she did not think that any information from her scan would make her change her decision to keep the baby. She had lost some weight, which she attributed to morning sickness, but her weight loss had been more severe than in her first pregnancy. She sometimes had abdominal pain.
If metastasis from choriocarcinoma is suspected, these investigations are necessary.