Fetal sac miscarriage
Blighted Ovum (Anembryonic Pregnancy): Causes & Symptoms
Overview
A blighted ovum is when the gestational sac containing the embryo is empty.What is a blighted ovum?
A blighted ovum (also called an anembryonic pregnancy) is a type of early miscarriage that occurs when a fertilized egg implants into the uterus but does not develop into an embryo. The embryo will stop growing, but the gestational sac (where the embryo would develop) continues to grow. The placenta and empty gestational sac will release pregnancy hormones — even without an embryo present. This causes you to have early symptoms of pregnancy or even have a positive pregnancy test. Sometimes it occurs so early in pregnancy that you don't know you're pregnant.
When does a blighted ovum happen?
A blighted ovum causes an early miscarriage in the first trimester of pregnancy. During fetal development, a fertilized egg turns into a blastocyte. At around four weeks of pregnancy, this blastocyte implants in the wall of the uterus and develops into an embryo. When you have a blighted ovum, the gestational sac that would hold the embryo continues to grow, even without an embryo present. The following can occur:
- A blighted ovum happens so early in pregnancy, that you never realize you are pregnant.
- You have a positive pregnancy test and signs of pregnancy only to discover a blighted ovum at your first ultrasound.
- You have a positive pregnancy test and signs of pregnancy but then experience a miscarriage.
How common is a blighted ovum pregnancy?
A blighted ovum is the number one cause of first trimester miscarriages.
Symptoms and Causes
What are the symptoms of a blighted ovum?
A blighted ovum can occur so early in pregnancy that you never knew you were pregnant. In other cases, you may experience signs of pregnancy such as a missed menstrual period or a positive pregnancy test. You can have symptoms of early pregnancy, such as breast tenderness and morning sickness.
Other times your symptoms will resemble those of a miscarriage:
- Vaginal bleeding: Spotting (light bleeding), bleeding or passing light gray tissue or blood clots.
- Cramping: Mild to moderate cramping in your pelvic and abdominal region.
The only way to confirm a blighted ovum is through an ultrasound. It will show a gestational sac that is missing an embryo inside.
What causes a blighted ovum?
A blighted ovum is usually caused by chromosomal or genetic problems during cell division. During conception, the egg will begin to divide shortly after being fertilized by sperm. Around ten days later, the cells have formed an embryo. With a blighted ovum, the embryo never forms or stops growing after it’s formed.
How does a blighted ovum miscarriage start?
A blighted ovum miscarriage will cause vaginal bleeding and abdominal cramping. A miscarriage usually feels more intense than your regular menstrual period. You can take an over-the-counter medicine like acetaminophen to relieve cramping. Avoid lifting anything heavy or any strenuous exercise as it can increase your bleeding. You may experience spotting for several weeks after a miscarriage.
Diagnosis and Tests
How is a blighted ovum diagnosed?
Your healthcare provider will diagnose a blighted ovum using transvaginal ultrasound. This happens in the first trimester, usually between seven and nine weeks of pregnancy. An embryo should be visible at this time in pregnancy. With a blighted ovum, the gestational sac will be empty.
- You will lie back on an exam table and place your feet in stirrups like you do for a pelvic exam. Your healthcare provider will put an ultrasound wand into your vagina to see the contents of your uterus.
- A blighted ovum will appear as an empty sac — almost like a bubble.
A blighted ovum is when the gestational sac containing the embryo is empty.
People are often unaware that they have a blighted ovum. This is because your placenta continues to give off hormones, making your body think you are pregnant. This is also why you can still have symptoms of pregnancy, including a positive pregnancy test.
If you’ve already experienced bleeding or signs of a miscarriage, your healthcare provider will use ultrasound to look at the contents of your uterus to diagnose a blighted ovum.
Some healthcare providers will collect a series of blood samples that check the levels of hCG (human chorionic gonadotropin) in your body. HCG is known as the pregnancy hormone because it's only produced if you are pregnant. The level of hCG in your blood increases rapidly in early pregnancy and reaches its peak around weeks eight to ten. If it's not rising quickly, it can indicate a miscarriage or other complication. Your provider may decide to test your hCG levels over the course of several days to evaluate how your hCG levels are rising. This can be an effective tool for diagnosing blighted ovum.
Management and Treatment
How is a blighted ovum treated?
For some people, there may be no treatment needed, because your body passes the embryo through your vagina (a miscarriage).
If your body does not miscarry the embryo, there are other options to remove the contents of your uterus. Your healthcare provider will talk you through possible treatments:
- Dilation & Curettage (D&C): This is a surgical procedure to remove the contents of your uterus. Your healthcare provider will dilate, or open, the cervix and use medical tools and suction to remove the pregnancy tissues from your uterus. This is done under sedation or general anesthesia.
- Natural miscarriage: If it's safe, you may be able to watch and wait to see if your body eventually releases the pregnancy tissues. It can sometimes take days or weeks for this to start. Your healthcare provider will let you know if this is an option for you. You will experience cramping, abdominal pain and bleeding once the miscarriage begins.
- Medication-induced miscarriage: You may be given a medication called misoprostol to trigger your body to miscarry.
This moves the process along and eliminates the time waiting for a miscarriage to start on its own. You will have cramping, abdominal pain and bleeding within 30 minutes to ten hours of taking the medication.
A follow-up appointment is usually scheduled four to six weeks after a miscarriage or D&C. You may be given another ultrasound to confirm the uterus is empty. Your healthcare provider will check for signs of infection and make sure there were no complications.
What are the complications of a blighted ovum?
Complications of a blighted ovum are uncommon, but the possible complications could include:
- Excessive bleeding or hemorrhage.
- Infection.
- Scarring (from the D&C procedure).
- Tears in the uterus (from the D&C procedure).
How long does it take to recover from a blighted ovum?
Recovering from a blighted ovum miscarriage or D&C can last from one or two weeks to a month. Cramping generally lasts up to a week, but bleeding can last several weeks.
Your bleeding should get lighter until it stops completely.
You can resume normal activities when you feel comfortable. Bleeding can increase with strenuous activity or exercise. Hormones may remain in your body and delay your menstrual cycle. Most people will get their period within four to six weeks after a blighted ovum.
It may take longer to recover emotionally from a blighted ovum miscarriage. You may have feelings of sadness, anger or confusion. It’s OK to take time to grieve. Ask your friends and family for support.
Prevention
Can a blighted ovum be prevented?
A blighted ovum can’t be prevented. Some couples may want to do genetic testing on the tissue inside the uterus. This checks for underlying causes of your miscarriage and can be helpful to couples who have experienced multiple pregnancy losses.
Outlook / Prognosis
How soon after a blighted ovum can I get pregnant again?
Most healthcare providers recommend having one or two regular menstrual cycles before trying to conceive again after any type of miscarriage.
What are my chances of having another blighted ovum?
Your chances of having another blighted ovum are low. Most people go on to have healthy, full-term pregnancies. If you experience more than one blighted ovum, your healthcare provider may suggest testing to determine if there is an underlying cause.
Living With
When should I see my healthcare provider?
Call your healthcare provider right away if you have any of these symptoms:
- Excessive bleeding from your vagina.
- Dizziness or fainting.
- Fever that does not go away.
- Symptoms that get worse over time.
- Severe pain that isn’t helped with pain medicine.
When should I go to the ER?
Go to the nearest ER If you experience heavy vaginal bleeding — more than two pads per hour for two consecutive hours — or have symptoms of anemia like dizziness, palpitations or paleness.
What questions should I ask my doctor?
Losing a pregnancy is upsetting and confusing.
Do not be embarrassed to ask any questions you have. It's completely normal to have questions and feel emotional during this time. Some questions you may ask are:
- Can I let my body miscarry or should I take medication to induce a miscarriage?
- What are the risks of miscarriage?
- Do I have to have a D&C?
- What are the risks of a D&C?
- How long can I expect to bleed or have cramping?
- Is there any indication this will happen again?
- When can I start trying to conceive?
- Do I need to come back for another ultrasound?
Frequently Asked Questions
Is a blighted ovum considered a miscarriage?
Yes, a blighted ovum is a miscarriage. A miscarriage is a loss of pregnancy before 20 weeks. A blighted ovum is considered an early miscarriage because it occurs before 13 weeks of pregnancy.
How long can you carry a blighted ovum?
The amount of time you can carry a blighted ovum varies.
Your placenta will continue to grow and release hormones without an embryo. For some people, a miscarriage can occur within a few days or weeks. Others may still believe they are pregnant only to discover a blighted ovum at their first ultrasound.
Can a blighted ovum turn into a baby?
No, an empty gestational sac will not turn into an embryo. The formation of the embryo occurs within two weeks of conception. By the time the gestational sac is formed, the cells should have already formed the embryo. Your healthcare provider will be able to examine your gestational sac to confirm that no embryo has developed.
Do hCG levels rise with blighted ovum?
Yes, most of the time hCG levels will rise, giving you a positive pregnancy test and symptoms of pregnancy. This is because the placenta continues to give off hCG even if an embryo is not present. The hormone hCG is sometimes called the pregnancy hormone because it is only produced if you are pregnant.
Is a blighted ovum more common with IVF?
A blighted ovum is not more common with IVF (In Vitro Fertilization).
Your chances of having a blighted ovum with IVF treatment are about the same as they would be with a natural conception.
A note from Cleveland Clinic
Losing a pregnancy is difficult. If you are struggling after a miscarriage, speak with your healthcare provider so they can recommend support groups or counselors. Finding support may help you get through this hard time. Most people who have had a blighted ovum will go on to have a healthy pregnancy.
Blighted Ovum (Anembryonic Pregnancy): Causes & Symptoms
Overview
A blighted ovum is when the gestational sac containing the embryo is empty.What is a blighted ovum?
A blighted ovum (also called an anembryonic pregnancy) is a type of early miscarriage that occurs when a fertilized egg implants into the uterus but does not develop into an embryo. The embryo will stop growing, but the gestational sac (where the embryo would develop) continues to grow. The placenta and empty gestational sac will release pregnancy hormones — even without an embryo present.
This causes you to have early symptoms of pregnancy or even have a positive pregnancy test. Sometimes it occurs so early in pregnancy that you don't know you're pregnant.
When does a blighted ovum happen?
A blighted ovum causes an early miscarriage in the first trimester of pregnancy. During fetal development, a fertilized egg turns into a blastocyte. At around four weeks of pregnancy, this blastocyte implants in the wall of the uterus and develops into an embryo. When you have a blighted ovum, the gestational sac that would hold the embryo continues to grow, even without an embryo present. The following can occur:
- A blighted ovum happens so early in pregnancy, that you never realize you are pregnant.
- You have a positive pregnancy test and signs of pregnancy only to discover a blighted ovum at your first ultrasound.
- You have a positive pregnancy test and signs of pregnancy but then experience a miscarriage.
How common is a blighted ovum pregnancy?
A blighted ovum is the number one cause of first trimester miscarriages.
Symptoms and Causes
What are the symptoms of a blighted ovum?
A blighted ovum can occur so early in pregnancy that you never knew you were pregnant. In other cases, you may experience signs of pregnancy such as a missed menstrual period or a positive pregnancy test. You can have symptoms of early pregnancy, such as breast tenderness and morning sickness.
Other times your symptoms will resemble those of a miscarriage:
- Vaginal bleeding: Spotting (light bleeding), bleeding or passing light gray tissue or blood clots.
- Cramping: Mild to moderate cramping in your pelvic and abdominal region.
The only way to confirm a blighted ovum is through an ultrasound. It will show a gestational sac that is missing an embryo inside.
What causes a blighted ovum?
A blighted ovum is usually caused by chromosomal or genetic problems during cell division. During conception, the egg will begin to divide shortly after being fertilized by sperm.
Around ten days later, the cells have formed an embryo. With a blighted ovum, the embryo never forms or stops growing after it’s formed.
How does a blighted ovum miscarriage start?
A blighted ovum miscarriage will cause vaginal bleeding and abdominal cramping. A miscarriage usually feels more intense than your regular menstrual period. You can take an over-the-counter medicine like acetaminophen to relieve cramping. Avoid lifting anything heavy or any strenuous exercise as it can increase your bleeding. You may experience spotting for several weeks after a miscarriage.
Diagnosis and Tests
How is a blighted ovum diagnosed?
Your healthcare provider will diagnose a blighted ovum using transvaginal ultrasound. This happens in the first trimester, usually between seven and nine weeks of pregnancy. An embryo should be visible at this time in pregnancy. With a blighted ovum, the gestational sac will be empty.
- You will lie back on an exam table and place your feet in stirrups like you do for a pelvic exam.
Your healthcare provider will put an ultrasound wand into your vagina to see the contents of your uterus. - A blighted ovum will appear as an empty sac — almost like a bubble.
A blighted ovum is when the gestational sac containing the embryo is empty.
People are often unaware that they have a blighted ovum. This is because your placenta continues to give off hormones, making your body think you are pregnant. This is also why you can still have symptoms of pregnancy, including a positive pregnancy test.
If you’ve already experienced bleeding or signs of a miscarriage, your healthcare provider will use ultrasound to look at the contents of your uterus to diagnose a blighted ovum.
Some healthcare providers will collect a series of blood samples that check the levels of hCG (human chorionic gonadotropin) in your body. HCG is known as the pregnancy hormone because it's only produced if you are pregnant. The level of hCG in your blood increases rapidly in early pregnancy and reaches its peak around weeks eight to ten.
If it's not rising quickly, it can indicate a miscarriage or other complication. Your provider may decide to test your hCG levels over the course of several days to evaluate how your hCG levels are rising. This can be an effective tool for diagnosing blighted ovum.
Management and Treatment
How is a blighted ovum treated?
For some people, there may be no treatment needed, because your body passes the embryo through your vagina (a miscarriage). If your body does not miscarry the embryo, there are other options to remove the contents of your uterus. Your healthcare provider will talk you through possible treatments:
- Dilation & Curettage (D&C): This is a surgical procedure to remove the contents of your uterus. Your healthcare provider will dilate, or open, the cervix and use medical tools and suction to remove the pregnancy tissues from your uterus. This is done under sedation or general anesthesia.
- Natural miscarriage: If it's safe, you may be able to watch and wait to see if your body eventually releases the pregnancy tissues.
It can sometimes take days or weeks for this to start. Your healthcare provider will let you know if this is an option for you. You will experience cramping, abdominal pain and bleeding once the miscarriage begins. - Medication-induced miscarriage: You may be given a medication called misoprostol to trigger your body to miscarry. This moves the process along and eliminates the time waiting for a miscarriage to start on its own. You will have cramping, abdominal pain and bleeding within 30 minutes to ten hours of taking the medication.
A follow-up appointment is usually scheduled four to six weeks after a miscarriage or D&C. You may be given another ultrasound to confirm the uterus is empty. Your healthcare provider will check for signs of infection and make sure there were no complications.
What are the complications of a blighted ovum?
Complications of a blighted ovum are uncommon, but the possible complications could include:
- Excessive bleeding or hemorrhage.
- Infection.
- Scarring (from the D&C procedure).
- Tears in the uterus (from the D&C procedure).
How long does it take to recover from a blighted ovum?
Recovering from a blighted ovum miscarriage or D&C can last from one or two weeks to a month. Cramping generally lasts up to a week, but bleeding can last several weeks. Your bleeding should get lighter until it stops completely.
You can resume normal activities when you feel comfortable. Bleeding can increase with strenuous activity or exercise. Hormones may remain in your body and delay your menstrual cycle. Most people will get their period within four to six weeks after a blighted ovum.
It may take longer to recover emotionally from a blighted ovum miscarriage. You may have feelings of sadness, anger or confusion. It’s OK to take time to grieve. Ask your friends and family for support.
Prevention
Can a blighted ovum be prevented?
A blighted ovum can’t be prevented.
Some couples may want to do genetic testing on the tissue inside the uterus. This checks for underlying causes of your miscarriage and can be helpful to couples who have experienced multiple pregnancy losses.
Outlook / Prognosis
How soon after a blighted ovum can I get pregnant again?
Most healthcare providers recommend having one or two regular menstrual cycles before trying to conceive again after any type of miscarriage.
What are my chances of having another blighted ovum?
Your chances of having another blighted ovum are low. Most people go on to have healthy, full-term pregnancies. If you experience more than one blighted ovum, your healthcare provider may suggest testing to determine if there is an underlying cause.
Living With
When should I see my healthcare provider?
Call your healthcare provider right away if you have any of these symptoms:
- Excessive bleeding from your vagina.
- Dizziness or fainting.
- Fever that does not go away.
- Symptoms that get worse over time.
- Severe pain that isn’t helped with pain medicine.
When should I go to the ER?
Go to the nearest ER If you experience heavy vaginal bleeding — more than two pads per hour for two consecutive hours — or have symptoms of anemia like dizziness, palpitations or paleness.
What questions should I ask my doctor?
Losing a pregnancy is upsetting and confusing. Do not be embarrassed to ask any questions you have. It's completely normal to have questions and feel emotional during this time. Some questions you may ask are:
- Can I let my body miscarry or should I take medication to induce a miscarriage?
- What are the risks of miscarriage?
- Do I have to have a D&C?
- What are the risks of a D&C?
- How long can I expect to bleed or have cramping?
- Is there any indication this will happen again?
- When can I start trying to conceive?
- Do I need to come back for another ultrasound?
Frequently Asked Questions
Is a blighted ovum considered a miscarriage?
Yes, a blighted ovum is a miscarriage.
A miscarriage is a loss of pregnancy before 20 weeks. A blighted ovum is considered an early miscarriage because it occurs before 13 weeks of pregnancy.
How long can you carry a blighted ovum?
The amount of time you can carry a blighted ovum varies. Your placenta will continue to grow and release hormones without an embryo. For some people, a miscarriage can occur within a few days or weeks. Others may still believe they are pregnant only to discover a blighted ovum at their first ultrasound.
Can a blighted ovum turn into a baby?
No, an empty gestational sac will not turn into an embryo. The formation of the embryo occurs within two weeks of conception. By the time the gestational sac is formed, the cells should have already formed the embryo. Your healthcare provider will be able to examine your gestational sac to confirm that no embryo has developed.
Do hCG levels rise with blighted ovum?
Yes, most of the time hCG levels will rise, giving you a positive pregnancy test and symptoms of pregnancy.
This is because the placenta continues to give off hCG even if an embryo is not present. The hormone hCG is sometimes called the pregnancy hormone because it is only produced if you are pregnant.
Is a blighted ovum more common with IVF?
A blighted ovum is not more common with IVF (In Vitro Fertilization). Your chances of having a blighted ovum with IVF treatment are about the same as they would be with a natural conception.
A note from Cleveland Clinic
Losing a pregnancy is difficult. If you are struggling after a miscarriage, speak with your healthcare provider so they can recommend support groups or counselors. Finding support may help you get through this hard time. Most people who have had a blighted ovum will go on to have a healthy pregnancy.
Spontaneous abortion (miscarriage)
If the pregnancy is terminated naturally before the fetus reaches gestational age, this is called a spontaneous abortion or miscarriage. More than half of miscarriages occur no later than 12 weeks of gestation due to fetal abnormalities.
The rest falls on the period up to 20 weeks and is associated with pathologies of pregnancy. If the pregnancy is terminated in the second half, it is called preterm labor.
Spontaneous abortion, otherwise known as miscarriage, is one of the most common complications during pregnancy, accounting for 10-20% of diagnosed pregnancies, and is the rejection of a fetus weighing no more than 500 grams. and less than 22 weeks. Unfortunately, with such indicators, the fetus is not viable. Usually 80% of the total number of spontaneous abortions occurs before the 12th week of pregnancy. nine0003
Types of spontaneous abortion
1. Threat of miscarriage - characterized by mild uterine cramps, pulling pain in the lower abdomen and sometimes mild bloody discharge from the vagina.
2. A miscarriage that has begun - is characterized by more severe pain and profuse bleeding. At the same time, the tone of the uterus is slightly increased, and the internal os is closed.
3.
Inevitable miscarriage - accompanied by dilatation of the cervix - a fetal egg can be distinguished - with profuse bleeding and severe cramps in the lower abdomen. nine0003
4. Incomplete miscarriage - part of the fetus comes out. The bleeding is so profuse that it can lead to the death of a woman.
5. Completed miscarriage - the fetal egg and the fetus itself are completely out. After that, the bleeding and spasms stop.
The etiology of miscarriage is due to many factors. Among them:
- genetic disorders;
- previous induced abortions;
- too little time has passed since the previous pregnancy; nine0003
- inflammatory infections in the mother, endocrine disorders;
- blood conflict between mother and fetus;
- taking hormonal contraceptives and certain medications;
- smoking during pregnancy and drinking alcohol;
- unknown causes.
To prevent miscarriage, it is necessary to give up bad habits, not to have abortions and to be regularly examined by a doctor.
Spontaneous abortion begins with the appearance of cramping, drawing pains, similar to pain during menstruation. Then bleeding from the uterus begins. At first, the discharge is slight or moderate, and then, after detachment of the fetal egg, abundant discharge with bloody clots begins. The appearance of these symptoms requires urgent hospitalization. nine0003
After examining a woman in a hospital, having determined the degree of detachment of the embryo, one of the following diagnoses will be made:
- the threat of pregnancy - detachment is only outlined or is completely insignificant. In this case, the pregnancy can be saved;
- a miscarriage that has begun - detachment is already quite decent with a pronounced pain syndrome. And in this case, the fetus can be saved;
- abortion in progress - detachment with displacement progresses, labor-like contractions begin. Pregnancy cannot be saved, cleaning is required; nine0003
- incomplete miscarriage - independent exit of a part of the fetus and membranes, curettage is necessary for the final curettage of the uterus;
- late abortion - premature delivery of an unviable baby.
After a spontaneous abortion, it is recommended to take a short break in planning and take preventive measures to avoid recurrence.
In case of repeated miscarriage, a thorough comprehensive examination is necessary to determine the causes of miscarriage and eliminate them. nine0003
A miscarriage is a severe psychological trauma, especially during the first pregnancy. But do not give up, with a competent approach to planning and bearing, the next pregnancy will certainly end with the appearance of a long-awaited baby.
Causes of spontaneous abortion
1. Doctors call various chromosomal pathologies one of the main reasons: monosomy, autosomal trisomies, polyploidy. They account for 82-88% of spontaneous miscarriages.
2. The second most common cause is disorders in the female genital area: endometritis - inflammation of the uterine mucosa - preventing the implantation of the fetal egg and its development and polycystic ovaries. nine0003
3.
Hormonal disorders, namely progesterone deficiency.
4. Chronic diseases - uncontrolled diabetes mellitus, high blood pressure.
5. Viral infections rubella, chlamydia and others.
Treatment
In case of severe blood loss, ultrasound is performed to determine the viability of the fetus and rule out an ectopic pregnancy. The woman is prescribed bed rest and is treated with antispasmodic drugs to relax the uterine myometrium and stop bleeding. nine0003
If doctors still diagnose a spontaneous abortion that has begun, then the actions are reduced either to expectant tactics (within 2-6 weeks the fetal egg should come out by itself), or to prescribing drugs that accelerate the delivery of the fetus, or to vacuum aspiration (medical abortion ).
Started miscarriage
Spontaneous miscarriage
Miscarriage, or abortion (abortus), is the termination of pregnancy during the first 28 weeks. Depending on the period when the termination of pregnancy occurred, miscarriages are divided into early and late.
Early miscarriages include abortions before 14 weeks, late - from 14 to 28 weeks of pregnancy. Termination of pregnancy can be carried out artificially (abortus artificialis), and can occur spontaneously, regardless of the desire of the woman. Such a miscarriage is called a spontaneous miscarriage, or abortion (abortus spontaneus). If a woman has spontaneous miscarriages, they are habitual miscarriages (abortus spontaneus habitualis). Before analyzing the various causes of spontaneous abortion, it is necessary to remember what processes that occur in a woman's body precede pregnancy and what changes make it possible to carry a pregnancy and normal intrauterine development of the fetus. nine0003
Pregnancy is possible only in a woman who has a normal biphasic menstrual cycle. Most women have a menstrual cycle of 28 days. In the first half of the cycle, i.e., in the first 14 days, the follicle grows and matures in the ovary. As a result of this complex process, a mature egg is located in the follicle, ready for fertilization.
During this so-called follicular phase, estrogen hormones are formed in the ovary, which enter the bloodstream and cause cell reproduction and gland growth in the uterine mucosa, i.e., a proliferation process is observed in the endometrium. Therefore, the first half of the menstrual cycle is called the proliferation phase. nine0083 As soon as the developing follicle reaches the stage of maturity, ovulation occurs. Ovulation is the process of rupture of the shell of a large follicle and the release of a mature egg from it.
In place of the ruptured follicle, from the cells of the granular membrane lining the cavity of the follicle, a new endocrine gland, very important for subsequent pregnancy, is formed - the corpus luteum. The hormone of the corpus luteum - progesterone - causes complex changes in the uterine mucosa, due to which the functional layer of the endometrium prepares for the perception of a fertilized egg. The second half, or phase of the uterine menstrual cycle, is called the secretory phase.
nine0003
When pregnancy occurs, the corpus luteum continues to develop, the release of progesterone increases. This leads to the fact that pregnancy-specific changes occur in the stroma of the functional layer of the endometrium, called the decidual reaction. Therefore, for the onset of pregnancy, it is necessary that ovulation occurs in the ovary, and secretory and decidual transformations of the mucous membrane occur in the uterus.
The influence of the corpus luteum hormone on the uterus is not limited to changes occurring in the endometrium, the degree of which is directly dependent on the amount of hormone produced by the ovary. Progesterone, in addition, reduces the excitability of the uterus, reduces the lumen of the cervical canal and thus contributes to the normal development of pregnancy. nine0003
There are many reasons for miscarriage. One of the most common factors is the underdevelopment of the genital organs. In this condition, called infantilism, there may be a functional inferiority of the ovary, manifested in insufficient formation of estrogen, in the insufficiency of the corpus luteum, and also in the underdevelopment of the uterus.
In the presence of sexual infantilism, spontaneous miscarriage can also be caused by increased excitability of the uterus and insufficiency of decidual transformation of the endometrial stroma, and as a result, the occurrence of unfavorable conditions for the development of the fetal egg. nine0003
The next, often occurring, cause of spontaneous termination of pregnancy is past inflammatory diseases of the uterus (endomyometritis) and traumatic injuries of various parts of the uterus, which may result in dystrophic or cicatricial changes in the mucous and muscular membranes of the uterus.
Often, acute infectious diseases accompanied by high fever and intoxication, as well as chronic infections, can lead to abortion. nine0083 Especially often malaria, infectious hepatitis, toxoplasmosis, syphilis lead to abortion. In addition, pregnancy can spontaneously terminate when a pregnant woman is poisoned with mercury, lead, carbon monoxide, alcohol and other substances.
Currently, great importance in the etiology of spontaneous abortion is given to the pathology of the blood coagulation system.
Antiphospholipid syndrome, genetic thrombophilia lead to thrombosis of the chorionic vessels and subsequent detachment. In most cases, spontaneous abortion begins with detachment of the fetal egg from the uterine wall in a small area. In this case, the integrity of the blood vessels of the decidual membrane is violated. The spilled blood impregnates the membranes of the fetal egg. The onset of detachment is usually accompanied by uterine contractions, which, in turn, lead to the progression of detachment and to the death of the fetal egg. As a result of cramping contractions of the muscles of the uterus, the cervical canal opens and the ovum is expelled from the uterine cavity. nine0003
Each abortion is accompanied by bleeding, the intensity of which depends on the duration of pregnancy, as well as on the rate of detachment and expulsion of the ovum. With an early miscarriage, bleeding is always more abundant than with a late abortion. This is due to the fact that in early pregnancy, the entire surface of the fetal egg is covered with a fleecy membrane.
The villi are very delicate, some of them are separated from the wall of the uterus, and the other part is easily torn off and remains attached to the wall of the uterus, preventing the uterus from contracting and stopping bleeding. Therefore, detachment of any part of the fetal egg is accompanied by bleeding, which stops only after the removal of all remnants of the fetal egg from the uterine cavity. nine0003
As pregnancy progresses, in parallel with the growth of trophoblast villi in the area of the future placenta, the rest of the surface of the fetal egg is gradually freed from villi, so late miscarriages proceed according to the type of childbirth, i.e., first, the cervix opens, then the water leaves, the fetus is expelled , and then separated and the afterbirth is born. As in childbirth, bleeding in a late miscarriage occurs at the time of separation and birth of the placenta.
During a spontaneous miscarriage, several stages can be distinguished, the diagnosis of which is very important for providing correct and timely assistance to a pregnant woman (Fig.
1). In the first stage, which is called a threatened miscarriage (abortus imminens), the connection of the fetal egg with the uterine wall is broken in a small area. At the same time, a pregnant woman notes slight pulling pains in the lower abdomen. With a late miscarriage, the pain is cramping in nature. Bleeding is usually absent, sometimes there may be scanty spotting. A two-handed vaginal examination reveals a closed external os, the cervix of the usual length, the body of the uterus in size corresponds to the gestational age. The uterus is very easily excitable. nine0003
Stages of miscarriage.
a - threatening miscarriage; b - a miscarriage that has begun; 1 - body of the uterus, 2 - cervix, 3 - fetal egg, 4 - hematoma
associated with the wall of the uterus. If the applied therapy at this stage of the process turns out to be effective and further detachment of the fetal egg stops, then it is possible to continue the normal development of the embryo.
When an abortion has begun, the pregnant woman feels mild pain of a cramping nature, accompanied by bloody discharge in a small amount. The external uterine os, as a rule, is slightly ajar, the cervical canal can be passable for one finger. nine0003
Both in case of threatened and incipient miscarriage, treatment should be aimed at reducing the excitability of the uterus and stopping further detachment of the ovum. The pregnant woman needs to be hospitalized.
If the therapy fails or if treatment is not carried out, the miscarriage that has begun proceeds to the next stage of the process - abortion in progress (abortus progrediens), in which the exfoliated fetal egg is expelled from the uterine cavity (Fig. 5). At the same time, the woman's cramping pains increase, bleeding increases. With spontaneous miscarriage during the early period, bleeding can be very strong, quickly leading the woman to severe anemia. Produced vaginal examination helps to easily establish the correct diagnosis.
At the same time, an open external pharynx is detected, the cervix is enlarged in volume due to the fetal egg located in the cervical canal, the lower pole of which can even protrude into the vagina. Treatment of abortion in the course is reduced to the removal of the fetal egg, followed by curettage of the uterine cavity. nine0003
Abortion in progress.
1 - uterine body, 2 - cervix, 3 - fetal egg, 4 - hematoma.
Incomplete miscarriage.
a — all membranes in the uterus; b - in the uterus the remains of the fetal egg.
With a miscarriage in the course of the late term, heavy bleeding, as a rule, does not happen. Therefore, in late pregnancy, it is advisable to wait for the independent birth of the fetus and placenta, and then perform a digital or instrumental examination of the uterus.
In case of spontaneous miscarriage, especially early, the fetal egg is rarely completely separated from the walls of the uterus. Usually, a part of the fetal egg exfoliates and is born, and a part remains in the uterine cavity (Fig.
6). Such an incomplete miscarriage is accompanied by profuse bleeding with clots. If a small part of the fleecy membrane is retained in the uterine cavity, then the bleeding may not be very intense, but prolonged. The remains of the fetal egg in the uterine cavity can cause not only bleeding that threatens the health and sometimes the life of a woman, but also a serious infectious disease. Therefore, the diagnosis of incomplete miscarriage should be timely. The diagnosis of incomplete abortion is established on the basis of subjective and objective data. When collecting a history of a woman’s disease, it is necessary to find out the date of the last normal menstruation, the duration of amenorrhea, when and in connection with what bleeding appeared, when the miscarriage occurred. During vaginal examination, an open cervical canal is determined, freely passing a finger through the internal pharynx. The uterus does not correspond in size to the gestational age, its size is smaller, since part of the fetal egg has already been born.
