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Yvette is a 28-year-old Asian female who walked in without an appointment to be seen for vaginal bleeding. She is an established patient who is 16 weeks pregnant, and this is her first pregnancy. She is crying and accompanied by her husband. A medical assistant escorts them to a room. Her blood pressure is 138/88 mmHg, pulse 84, respirations 16, temperature 98.4°F and her weight is 145 lb. A urine sample has been obtained. A review of her prenatal care record reveals that she had a normal initial exam, normal lab values and screening tests, takes prenatal vitamins and folic acid, size equals dates, fetal heart tones obtained by Doppler at 14 weeks were 167 bpm, and she is Rh negative. A pelvic exam is performed with a small amount of dark red blood seen in the vaginal vault. The cervix appears closed and there is no visible discharge at the cervix or in the vagina. A wet prep and sample for chlamydia and gonorrhea are gathered. The uterus is palpated and the uterine size equals dates, the external cervical is is closed. No fetal heart tones are heard via Doppler. The wet prep demonstrates many red blood cells, small amount of white blood cells, normal squamous epithelial cells, a moderate amount of bacteria, no spores or pseudohyphae, no trichomonas, and the whiff test is negative.
1. What history should be gathered?
2. What labs should be collected at this time?
3. What are your differential diagnoses for this patient?
4. What is the next diagnostic modality that should be performed?
5. What interventions, if any, should be taken at this time?



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