Gestational sac miscarriage picture 8 weeks

Photos Show Pregnancy Tissue Before 10 Weeks

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• Abortion is restricted in many US states, including 13 where the procedure is illegal at any stage of pregnancy.
• Most abortions in the US take place before the embryo is visible to the naked eye.
• Clinicians with the MYA Network are sharing what early pregnancy tissue really looks like.

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Few people know what pregnancy tissue looks like in the first trimester.

Most images of pregnancy show a fetus in the later stages of development, which leaves an information gap for the earliest stages of pregnancy, Dr. Joan Fleischman told Insider.

Fleischman, a family doctor, has provided abortions for more than 25 years. She regularly removes tissue associated with early pregnancy, but most people don't get to see what she sees in her job.

This was the idea behind "The Issue of Tissue," a collection of photos of fetal tissue published by the MYA Network. The network includes doctors, patients, and activists seeking to counter misinformation about pregnancy and abortion.  

The first image in the series (pictured above) shows pregnancy tissue extracted at four weeks.

At this stage, Fleischman explained, most of the tissue associated with the pregnancy comes from the uterine lining (or decidua). This is the same lining that thickens every month ahead of a person's period, to support a potential pregnancy.

The embryo is not visible to the naked eye.

In the first nine weeks of pregnancy, the developing embryo is a microscopic cluster of cells.

Dr. Kristyn Brandi, an OB/GYN who was not involved in the project, told Insider that the photos of pregnancy tissue accurately depict what she sees when she provides abortion care or miscarriage management at this stage of pregnancy. 

"Usually we're seeing the sac and the decidua together," Brandi said. "Sometimes our jobs, in order to make sure that we've removed the pregnancy, involve weeding through the decidua in order to find this very, very tiny sac. But this is all we would see."

Fleischman told Insider that she removed the supportive tissue, or decidua, for most of the photos included in the project (with the exception of the four-week slide). This way, the tiny gestational sac — less than a half-inch wide at five weeks — is more easily visible.

There is no "heart" at six weeks of pregnancy.

At six weeks of pregnancy, some of the cells that will later form the heart begin to "beat."

This electrical activity can be seen on an ultrasound, giving rise to so-called "heartbeat bills" that ban abortion after six weeks.

However, the heart does not yet exist at six weeks of pregnancy. There are cells that will come together to form the heart, but they don't function as a heart until much later in the pregnancy.

In fact, many states outlaw abortion at before the fetus would be able to survive outside of the uterus. An embryo becomes a fetus at 10 weeks of pregnancy, but that fetus is unlikely to survive outside of a pregnant person until about 23 weeks gestation, Brandi said.

"This is what the vast majority of abortion care looks like," Brandi said.

"It's important to dispel myths about abortion and early pregnancy care — that it's not necessarily what people see on billboards that anti-choice people carry," she continued.  

With "The Issue of Tissue," the MYA network aims to fill the information gap surrounding early pregnancy.

"We're not saying anything about a good or bad time to end a pregnancy," Fleischman told Insider. "We're simply saying this is missing information that was out there, and I think you can see from the response that people are pretty surprised by what it looks like."

Around 85% of all abortions in the US happen before nine weeks of pregnancy, according to the MYA Network.

At this stage, pregnant patients may opt to get a medical or surgical abortion in states where the procedure is legal.

For an in-clinic abortion, most providers will use a handheld suction device to remove early pregnancy tissue.

Alternatively, people can opt to take two pills for a mostly at-home abortion. Some states require that the first pill, mifepristone, be taken in a doctor's office, but patients can also safely and effectively take these medications at home. 

Accurate imagery can help support family planning.

Regardless of how someone feels when they become pregnant, the images that are available to them do not usually support all of their options, Fleischman said.

"Seeing what it actually looks like when it comes out is helpful to support people to make the decision they need to make," she said.

Brandi said that a lot of her patients have asked her if they could look at their pregnancy tissue after their abortions or miscarriages. Having access to photos like these ahead of time could help them make informed decisions about their pregnancies, she said.

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What a pregnancy actually looks like before 10 weeks – in pictures | Abortion

Abortion is now banned or severely restricted in 14 states in the US, the outcome of a decades-long campaign by anti-abortion advocates. In many states, abortion is no longer seen as a health procedure, but a morality issue. Pennsylvania’s Doug Mastriano – once a state senator, now running for governor – is one of a number of Republican politicians who has called for murder charges for people who defy abortion bans.

In 13 of those 14 states, abortion is banned even in the earliest stages of pregnancy.

These images, supplied to us by the MYA Network, a network of clinicians and activists who came together earlier in the pandemic when some states tried to classify abortion as “non-essential” medical care, show what tissue in the first nine weeks of pregnancy actually looks like.

Above is early pregnancy tissue, at four weeks of pregnancy.

Dr Joan Fleischman, part of the MYA Network, uses a gentle handheld device that removes the tissue. This more delicate type of extraction keeps it intact.

Above is pregnancy tissue extracted at five weeks.

Sometimes, patients want to see the tissue after an abortion. “They are stunned by what it actually looks like,” says Fleischman. “That’s when I realized how much the imagery on the internet and on placards – showing human-like qualities at this early stage of development – has really permeated the culture. People almost don’t believe this is what comes out.”

Above is tissue removed at six weeks, when misleadingly named “fetal heartbeat” bills outlaw abortion.

“Clinicians date pregnancy from the first day of your last period, to help predict the due date. But you’re not pregnant for those first two weeks,” says Fleischman. So someone with a six-week pregnancy may have very little time after a missed period to get abortion care in states with a six-week limit.

Many images on the internet and in textbooks show development to be quite far along at this stage.

“A lot of early pregnancy images are driven by people who are against abortion and feel that life begins at conception, or by prenatal enthusiasts who want women to be excited about their pregnancy. What about people who aren’t?” she asks.

Above is pregnancy tissue at seven weeks. There is still no visible embryo. The gestational sac is not yet half an inch. “I have been in the training field, and medical students and clinicians who see it are also shocked. That is how pervasive this misinformation is,” Fleischman says.

Patients may come in for an abortion fearful at this stage, having read through forums or looked at images online. “They’re expecting to see a little fetus with hands – a developed, miniature baby.” Often, she says, “they feel they’ve been deceived.”

This image shows decidua (tissue to support the pregnancy) and the gestational sac (which would eventually become the amniotic sac, which supports the fetus). If we looked closer, under a microscope, would we see more human qualities?

“If you zoom in on anything, including sperm and an egg getting fertilized, it’s just an incredible thing to watch. But that’s very different from the everyday ways we see life. That perspective to me is the most relevant – but it is somehow absent from our consciousness,” says Fleischman.

Above is a gestational sac removed at eight weeks of pregnancy. While these images relate to early pregnancy, the network does not differentiate between a “good time” and a “bad time” to have an abortion, nor does it dismiss how emotionally fraught losing a pregnancy at any stage, including early pregnancy, can be. But they want people to know what is actually being removed in early pregnancy.

“Abortion is medical care. Every single person who makes this decision is complex. But this information, showing tissue in the first 10 weeks, is literally absent from our common understanding of what is going on, and people deserve accurate information.”

This image shows the gestational sac of a nine-week pregnancy. This is everything that would be removed during an abortion and includes the nascent embryo, which is not easily discernible to the naked eye. Showing this tissue can be a relief to patients. “Often people don’t speak to anyone about getting an abortion. They make a very quiet, private decision because they’re afraid to see people’s reactions. And then I do this simple procedure that’s a few minutes longer than a Pap test. For those who choose to look at the tissue, you can literally feel the tension come down. People have been on this emotional roller coaster. And they’re like, ‘You’re kidding. This is all that was?’” says Fleischman.

Finally, above is a number of gestational sacs on one petri dish, showing the progression in growth from five weeks of pregnancy to nine weeks. The sac grows 1mm a day.

Talking about why we don’t see these images more often, Dr Michele Gomez, who is part of the MYA Network, says: “I do think there are some clinicians who are concerned about patient’s reactions. But it’s not really our right or our responsibility to decide how people will respond to this. We’re just putting out the information and the facts to counter the misinformation. To say: this is not something that’s scary, or dangerous, or violent. It’s just a picture of something that’s in your body.”

This article was amended on 19 October 2022 to include the detail that at nine weeks the nascent embryo is not easily discernible to the naked eye.

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.

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.

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;

- 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.

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;

- 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.

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.

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. A woman is prescribed bed rest and is treated with antispasmodic drugs to relax the uterine myometrium and stop bleeding.

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 ).

Save at all costs: reasons for abortion

January 17, 2017 Articles on gynecology

According to Wikipedia, 15-20% of clinically diagnosed pregnancies end in spontaneous abortion. These numbers are a lower estimate, as many miscarriages occur in the early stages, before the woman knows she is pregnant. After all, often the clinical signs of a miscarriage are mistaken for heavy periods or for their delay.

What are the reasons for termination of pregnancy at different terms? How to prepare for pregnancy after a bad experience that ended in a miscarriage? These questions were answered by an obstetrician-gynecologist of the highest category at Bullfinch Medical Center ALEXANDER GIL.

- Alexander Vadimovich, most miscarriages happen at the beginning of pregnancy, and many women are perplexed: why could this happen?

- The main cause of miscarriages before 6 weeks is natural selection. There is a laying of pregnancy with congenital malformations of the embryo, which is no longer viable - thus, natural selection is carried out, in which we cannot interfere.

You will never know the exact cause of a miscarriage at this time, even if after abrasion (curettage of the uterine mucosa), the contents are sent for research. As a rule, the answer comes: “short-term pregnancy” and nothing more.

There is another reason for termination of pregnancy, especially if it is not the first one - Rh-conflict (when a woman has Rh-negative blood, and men - Rh-positive). But in our country, effective prevention of the Rh conflict is used, so that troubles can be avoided at the stage of pregnancy planning.

In the structure of early termination of pregnancy, no one excludes infections and problems associated with hormones. At a period of 6-8 weeks, promising pregnancies are often interrupted due to a lack of hormones. During normal pregnancy, a woman has a so-called corpus luteum in one of the ovaries, which produces endogenous progesterone.

Unfortunately, the functioning of the corpus luteum ends by about 7 weeks of pregnancy, and if initially there was not enough endogenous progesterone, the pregnancy stops developing: the fetal egg detaches and the so-called missed pregnancy occurs.

In some cases, with detachment of the fetal egg, pregnancy can be saved, the main thing is to contact a specialist in time. If, based on the results of ultrasound studies, the doctor sees that the embryo is still alive, pregnant women are prescribed exogenous progesterone in tablets or suppositories. This hormone also exists in the form of injections - it is used to saturate the body faster and prevent miscarriage.

- Agree, when a woman becomes pregnant, she cannot suspect that she does not have enough progesterone in her body. What should be her concern? What signs indicate this?

- Any discharge ranging from scanty dark brown to more profuse bloody is a bad sign. You should not hesitate to contact a gynecologist.

If spotting appears, an ultrasound examination, a blood test for progesterone is indicated.

I want to say that lack of progesterone can cause miscarriage up to 15 weeks. At 15-16 weeks, the placenta is finally formed, which will secrete (produce) this hormone.

- Alexander Vadimovich, what problems can arise with the placenta during pregnancy?

- In the early stages, the chorion (unformed placenta) can block the internal os, maybe its marginal location - this is a big risk of abortion. In this case, the woman is admitted to the hospital and observed for up to 16 weeks - by this time, the chorion, as a rule, rises. But there remains a percentage of pregnant women in whom the placenta overlaps the cervix of the uterus - this is called the "central location of the placenta." To maintain pregnancy, such women, as a rule, must be in the clinic and under observation all the time.

— What is the treatment for infections that appear during pregnancy?

- Infections can occur even in women who were carefully examined before pregnancy. Often this problem occurs due to spotting - this is a favorable environment for the development of infections.

Ectopia (erosion) of the cervix is ​​also an infection that is a clear threat to pregnancy. Therefore, it is so important to undergo a colposcopy before conception and be treated for ectopia, if it is detected.

Infection by the ascending route can penetrate in utero and adversely affect the health of the fetus. There is such a complication as intrauterine fetal pneumonia, which is treated very poorly and occupies a large percentage in the structure of infant mortality.

And we treat infections whenever possible in any way that is prescribed in the protocol. There is such a tactic, which is to take antibiotics. There is no need to be afraid of them, as the doctor will prescribe only medicines approved for pregnant women. Sometimes you have to use those drugs, the benefits of which are greater than the risk of adverse reactions.

— What threats can affect a mid-term pregnancy?

— Among the many causes that lead to spontaneous miscarriages is isthmic-cervical insufficiency. This is a condition in which the isthmus and cervix cannot cope with the increasing load (growing fetus, amniotic fluid), begin to open - and the baby is born prematurely.

There are indications for the prevention of this condition - the imposition of a circular submucosal suture on the cervix. The best time is 16-17 weeks. You can do this procedure after 20 weeks, but the effect will be less.

In the middle of pregnancy, a placental abruption can occur in a woman. In some cases, pregnancy can be saved with the help of drugs that affect blood clotting. But often doctors are forced to resort to a small caesarean section. As a rule, childbirth before 22 weeks ends in the death of the fetus, and here we are already talking about saving the life of the mother.

I encourage pregnant women to refrain from flying. In my medical practice, there have been several cases where placental abruption in patients occurred during a flight. Who will provide you with qualified assistance in this case? I advise you not to take risks.

In Belarus, as in other European countries, labor begins at 22 weeks, but it is considered premature. Doctors are doing everything possible to save a promising pregnancy by any means. The main thing is to always be under the supervision of a specialist and follow all his recommendations.

- Alexander Vadimovich, unauthorized termination of a desired pregnancy is always a great psychological trauma for a woman. No one wants to experience this again. What are the features of preparing for the next pregnancy after a miscarriage?

— Before thinking about re-pregnancy, it is advisable for women who experience mental anguish to undergo a course of psychotherapy. This is very important, because mental problems can be very serious, especially in women after unsuccessful in vitro fertilization (IVF).

The main rule: do not get pregnant after a miscarriage for 6 months. It is best to protect yourself at this time with oral contraceptives, which the doctor will prescribe. This is necessary in order to restore normal reproductive function.

A set of examinations for women who have had a miscarriage is ordered individually. But the general recommendations are:

1. Diagnosis of sexually transmitted infections: mycoplasmosis, ureaplasmosis, chlamydia, herpes simplex virus, human papillomavirus (HPV).

You should also be screened for infections that may have caused a miscarriage in a previous pregnancy.

2. Test for sex hormones - if prescribed by a doctor.
3. Thyroid hormones (TSH, T4 free, ATPO), ultrasound of the thyroid gland, consultation with an endocrinologist.
4. If necessary, consultation of a therapist and other specialists, blood test for sugar, syphilis, HIV.
5. Ultrasound of the abdomen and kidneys. During pregnancy, many chronic diseases are exacerbated, incl. and kidney disease. You need to be treated before conception.
6. Colposcopy (examination of the cervix under a microscope).
7. Analysis of the spermogram of the partner.

An examination by a geneticist is indicated if, when planning a pregnancy, a woman is 36 years old, and a man is 45 years old and over. Also, this doctor should be visited by a couple who had two non-developing early pregnancies in a row.

Another tip from practice. Many women, having barely become pregnant, rush to confirm this on an ultrasound. Of course, there is no direct evidence that such research is harmful to the fetus, but there is also no evidence to the contrary that it is absolutely harmless. Since you so desire this pregnancy, it’s not worth the risk, and a competent doctor will definitely warn a woman against doing an early ultrasound without any special indications.

Pregnancy and its prospects can be determined using a blood test for hCG (human chorionic gonadotropin), or, more simply, the pregnancy hormone. It is absolutely harmless for pregnancy. It is advisable to donate blood at the beginning of the delay, a week later - again. If the increase in hCG is normal, then the pregnancy is promising, not ectopic - and there are no indications for ultrasound.

For the first time, a woman should come for ultrasound diagnostics at 11-12 weeks of pregnancy. Alexander Vadimovich Gil

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