An 18-year-old G0P0 female client tells a nurse midwife that she usually soaks a maxi sanitary pad in less than three hours every time she gets her period. Large clots are also passed. The client’s menstrual cycle lasts 30 days and her average duration of menstrual flow is 5 days. The client also informs the nurse that she usually experiences vaginal bleeding in between periods. The flow usually lasts for 2 days, and the amount of blood loss is the same as that of the blood loss during her regular menstrual period. Based on the history, the nurse midwife determines that the client has:
