A 35-year-old female presents at 11 weeks gestation with vaginal bleeding, abdominal cramping, and a closed cervix. What is the most likely diagnosis?

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In a scenario where a patient presents with vaginal bleeding and abdominal cramping during the first trimester of pregnancy, and the cervix is closed, the most likely diagnosis is a threatened abortion. This diagnosis is characterized by the presence of vaginal bleeding and/or abdominal pain while the cervix remains closed and the pregnancy is still viable, as indicated by an absence of significant dilation or expulsion of tissue.

The closed cervix suggests that the body has not progressed to a more advanced state of miscarriage, and despite the symptoms, the pregnancy may still be preserved. Patients with a threatened abortion are typically monitored for any changes, such as whether the bleeding persists or if there are complications like a miscarriage.

Diagnosis differs from other conditions like an inevitable or incomplete abortion, where there would be either cervical dilation or passage of some fetal tissue, indicating the pregnancy is ending or has already ended. A missed abortion entails a situation where the fetus has died but the products of conception are still retained in the uterus, typically without active bleeding or cramping. Hence, the symptoms presented align most closely with a threatened abortion.

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