A pregnant woman with a positive hCG and a closed cervix presents with bleeding and cramping. What condition is most likely?

The scenario describes a pregnant woman with a positive hCG level and a closed cervix who is experiencing bleeding and cramping. This presentation aligns with a threatened abortion, which is defined by the occurrence of vaginal bleeding during the first 20 weeks of pregnancy, along with uterine cramping, while the cervix remains closed.

In cases of a threatened abortion, despite the presence of bleeding and cramping, there is still a possibility that the pregnancy can continue. The fact that the cervix is closed is a positive indication that a miscarriage has not yet occurred. The management of a threatened abortion often involves reassurance and follow-up to monitor the status of the pregnancy.

This contrasts with other conditions such as inevitable abortion, where the cervix is open, and miscarriage is imminent; incomplete abortion, where some tissue is retained after a miscarriage and the cervix may be open; and complete abortion, which refers to an event where all fetal tissue has been expelled, often accompanied by a closed cervix after the event. Thus, the details provided in the question strongly support the conclusion of a threatened abortion as the correct diagnosis.