A 27-year-old female at 14 weeks gestation presents with vaginal discharge and abdominal tenderness. Her vital signs show hypotension. Which condition should you suspect?

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Vaginal bleeding with abdominal tenderness in a patient around 14 weeks gestation, especially with signs of shock, most strongly points to spontaneous abortion. Miscarriage is a common cause of vaginal bleeding in the first half of pregnancy and can lead to significant intrauterine bleeding, causing hypotension from blood loss. While ectopic pregnancy is a possible concern in pregnancies with pain and bleeding, it typically occurs earlier and often presents with localized unilateral pain; the overall presentation here aligns more with miscarriage. A molar pregnancy would usually show abnormal uterine enlargement and other signs from the excessive trophoblastic tissue, not just acute bleeding and tenderness. Hyperemesis gravidarum involves severe nausea and vomiting with weight loss, not vaginal bleeding. In this scenario, prioritize assessing and treating for potential hemorrhagic shock and expedite transport for definitive care.