A 34-year-old female presents with abdominal cramping and moderate vaginal bleeding. She had a positive pregnancy test six weeks ago. Which condition should you suspect?

• A. Spontaneous abortion
• B. Endometriosis
• C. Menstrual slough
• D. Ectopic pregnancy

Answer: (A)

In early pregnancy, vaginal bleeding with abdominal cramping is most often due to spontaneous abortion. The positive pregnancy test six weeks ago confirms recent pregnancy, and the combination of cramping with moderate bleeding is a classic presentation for miscarriage, where the pregnancy ends and tissue is shed. While ectopic pregnancy must be considered because it can mimic this picture and can be life-threatening, the scenario described fits spontaneous abortion more closely, especially in the absence of signs like localized severe pain, rupture, or hemodynamic instability. Endometriosis and menstrual slough are not consistent with an acute first-trimester bleeding episode in someone with a recent positive test. In the field, prioritize assessing stability, control bleeding, provide supportive care, and transport for definitive evaluation.