<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 40-year-old, gravida 2, nulliparous woman, at 14 weeks gestation comes to the physician because of a 6-hour history of light vaginal bleeding and lower abdominal discomfort. Eight months ago she had a spontaneous abortion at 10 weeks gestation. Her pulse is 92min, respirations are 18min, and blood pressure is 13476 mm Hg. Abdominal examination shows no tenderness or masses; bowel sounds are normal. On pelvic examination, there is old blood in the vaginal vault and at the closed cervical os. The uterus is larger than expected for the length of gestation and there are bilateral adnexal masses. Serum β-hCG concentration is 120,000 mIUml. Which of the following is the most appropriate next step in management?? A: Transvaginal ultrasound, B: Chorionic villus sampling, C: Thyroid function tests, D: Fetal blood sampling, E: Fetal Doppler ultrasound,  <response>: This is a clinical vignette about a pregnant woman with vaginal bleeding and abdominal discomfort. The key findings are:- 40-year-old woman, 14 weeks pregnant - History of spontaneous abortion 8 months ago- Light vaginal bleeding and lower abdominal discomfort for 6 hours- Vital signs are normal- Pelvic exam shows old blood in vaginal vault, closed cervical os, enlarged uterus, bilateral adnexal masses- Serum β-hCG is elevated at 120,000 mIUmlThe question is asking for the most appropriate next step in management. Based on the clinical presentation, the main concern is to evaluate the cause of vaginal bleeding and rule out complications like miscarriage, ectopic pregnancy, molar pregnancy, or uterine abnormalities. Option A, transvaginal ultrasound, is the best initial test to visualize the pregnancy, confirm viability, evaluate the uterus and adnexa, and look for potential causes of bleeding. Option B, chorionic villus sampling, is an invasive prenatal diagnostic test and not indicated as an initial step. Option C, thyroid function tests, may be reasonable but are not the most urgent or appropriate next step. Option D, fetal blood sampling, is too invasive as an initial step. Option E, fetal Doppler ultrasound, will not provide enough information about the uterus, adnexa, or potential causes of bleeding.Therefore, transvaginal ultrasound is the most appropriate next step to evaluate the cause of bleeding and assess pregnancy viability and anatomy.A: Transvaginal ultrasound 