In a patient at about 16 weeks gestation with vaginal bleeding and abdominal cramping, which diagnosis is most likely?

• A. Preterm birth
• B. Stillbirth
• C. Ectopic pregnancy
• D. Miscarriage

Answer: (D)

Vaginal bleeding with abdominal cramping around 16 weeks most strongly suggests miscarriage. A miscarriage is the loss of a pregnancy before about 20 weeks, and cramping with bleeding is a common presentation as the uterus contracts and expels tissue. At this gestational age, this is the most likely cause compared with other possibilities: an ectopic pregnancy typically occurs earlier and often presents with sharp, localized pain and risk of rupture; stillbirth refers to fetal death after viability (usually later in pregnancy) and preterm birth involves actual delivery before 37 weeks, which isn’t the scenario here. So the combination of mid-second-trimester bleeding and cramping best fits miscarriage.