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Blighted Ovum: Causes, Symptoms, and More

Written by Annie Stuart

In this Article

• What Causes a Blighted Ovum?
• Signs of a Blighted Ovum
• Diagnosing a Blighted Ovum
• What Happens After a Miscarriage?

A blighted ovum occurs when a fertilized egg implants in the uterus but doesn't develop into an embryo. It is also referred to as an anembryonic (no embryo) pregnancy and is a leading cause of early pregnancy failure or miscarriage. Often it occurs so early that you don't even know you are pregnant.

A blighted ovum causes about one out of two miscarriages in the first trimester of pregnancy. A miscarriage is when a pregnancy ends on its own within the first 20 weeks.

When a woman becomes pregnant, the fertilized egg attaches to the uterine wall. At about five to six weeks of pregnancy, an embryo should be present. At about this time, the gestational sac -- where the fetus develops -- is about 18 millimeters wide. With a blighted ovum, though, the pregnancy sac forms and grows, but the embryo does not develop. That's why a blighted ovum is also called an anembryonic pregnancy.

What Causes a Blighted Ovum?

Miscarriages from a blighted ovum are often due to problems with chromosomes, the structures that carry genes. This may be from a poor-quality sperm or egg. Or, it may occur due to abnormal cell division. Regardless, your body stops the pregnancy because it recognizes this abnormality.

It's important to understand that you have done nothing to cause this miscarriage and you almost certainly could not have prevented it. For most women, a blighted ovum occurs only once.

Signs of a Blighted Ovum

With a blighted ovum, you may have experienced signs of pregnancy. For example, you may have had a positive pregnancy test or a missed period.

Then you may have signs of a miscarriage, such as:

• Abdominal cramps
• Vaginal spotting or bleeding
• A period that is heavier than usual.

If you're experiencing any of these signs or symptoms, you may be having a miscarriage. But not all bleeding in the first trimester ends in miscarriage. So be sure to see your doctor right away if you have any of these signs.

Diagnosing a Blighted Ovum

If you thought you had a normal pregnancy, you're not alone; many women with a blighted ovum think so because their levels of human chorionic gonadotropin (hCG) may increase. The placenta produces this hormone after implantation. With a blighted ovum, hCG can continue to rise because the placenta may grow for a brief time, even when an embryo is not present.

For this reason, an ultrasound test is usually needed to diagnose a blighted ovum -- to confirm that the pregnancy sac is empty.

What Happens After a Miscarriage?

If you have received a diagnosis of a blighted ovum, discuss with your doctor what to do next. Some women have a dilation and curretage (D and C). This surgical procedure involves dilating the cervix and removing the contents of the uterus. Because a D and C immediately removes any remaining tissue, it may help you with mental and physical closure. It may also be helpful if you want a pathologist to examine tissues to confirm the reason for the miscarriage.

Using a medication such as misoprostol on an outpatient basis may be another option. However, it may take several days for your body to expel all tissue. With this medication, you may have more bleeding and side effects. With both options, you may have pain or cramping that can be treated.

Other women prefer to forego medical management or surgery. They choose to let their body pass the tissue by itself. This is mainly a personal decision, but discuss it with your doctor.

After a miscarriage, your doctor may recommend that you wait at least one to three menstrual cycles before trying to conceive again.

Anembryony - causes, symptoms | Diamed

Anembryony is a pathology of pregnancy, also known as "premature miscarriage" or "missed pregnancy". This type of miscarriage is one of the most common due to the difficulty of detection. In 60% of cases, this pathology can manifest itself for years without causing discomfort to a woman, especially if during this period of time the woman does not plan pregnancy and does not contact an obstetrician-gynecologist on this issue. Women suffering from disorders of the regularity of the menstrual cycle are more susceptible to this pathology.

Anembryony is a type of abnormal pregnancy in which conception occurs but the embryo does not develop.

Obstetrics, as a science, cannot always answer questions about the causes of this pathology. With anembryony, an empty fetal egg is diagnosed. That is, conception occurs, but the embryo in the early stages stops developing and dies for some reason, and ultrasound diagnostics give the impression of the absence of an embryo due to its small size. Most often, this pathology develops between the 5th and 9thth week of pregnancy.

If after this period the pregnancy is not interrupted and the embryo continues to develop, this pathology can no longer develop. If a woman did not go to the doctor or did not detect pregnancy in a timely manner, then in the event of the development of anembryonia, the embryo that stopped developing and died, along with the fetal egg, will leave the uterus naturally during the next menstrual bleeding, without causing inconvenience or discomfort to the woman. Anembryony, regardless of detection, leads to the independent exit of a dead embryo from the body of a woman and does not provoke inflammatory or infectious processes.

There is only one way to diagnose this pathology - ultrasound examination of the pelvic organs. If an ultrasound scan detects an empty fetal egg or the absence of embryo development, anembryonia is diagnosed.

Reasons for the development of anembronia

Obstetrics at this stage of development can not always establish the causes of the development of pathology, the most common are:

• Pathology at the genetic level. Currently considered the main cause of anembryos. The pathology of the female or male genetic material (eggs or sperm, respectively) causes anembryony. Even if the genetic material of one of the parents is normal, the pathogenic cell of the second will provoke a stop in the development of the embryo. Thus, in the treatment of this type of miscarriage, both partners should be diagnosed.
• Virus, infection, inflammation. Bacterial or viral infection, as well as an inflammatory process in any part of the female body, can stop the development of the embryo. Colds, dental diseases, inflammation of the genital organs, etc. promote the spread of pathogenic bacteria throughout the body. With reduced immunity, the risk of infection and subsequent death of the embryo increases.
• External factors. Ecological conditions, clean air, background radiation and other external factors can also cause anembryony.
• Hormonal causes. Any disturbances and malfunctions in the work of the endocrine system trigger the mechanisms of destruction of the embryo. If the mother does not suffer from endocrinological disorders, but the father has a hormonal imbalance, fetal death occurs due to sperm pathologies.

Prevention of anembronia

Prevention of pathology consists primarily in a woman's attentive attitude to her health and monitoring changes in her state of health and condition. Since anembryony develops in the earliest stages of pregnancy, in some cases, women will find out that they were pregnant after the death of the fetus or not at all. Such latent miscarriage is fraught with aggravation of the situation in the future, since it is impossible to cure a pathology that has not been detected.

The main prevention tip is early detection of pregnancy through a blood test, ultrasound or rapid test. If pregnancy is detected, you should immediately register and undergo a full diagnosis. Only a comprehensive study of the mother's health can prevent the development of most pregnancy pathologies in a timely manner.

Unfortunately, if the cause is the genetic material of one or both parents, it is impossible to avoid the death of the embryo even with early detection of pregnancy. However, having fixed this diagnosis, it is possible to carry out treatment, subsequent preparation for pregnancy and, as a result, a normal course of pregnancy without complications.

Come to "Diamed", they will definitely help you!

Anembryony. What is Anembryony?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Anembryony is a type of missed pregnancy in which, after fertilization and implantation, the egg does not develop into an embryo, but an empty fetal egg remains. Pregnancy does not progress, therefore, signs of toxicosis and other early symptoms in the form of drowsiness, pain in the mammary glands, and mood swings gradually disappear. Anembryonia is diagnosed by the results of ultrasound of the pelvic organs at the 5th week of pregnancy, can be confirmed by blood tests for hCG, alpha-fetoprotein. Specific treatment consists in removing the remnants of the embryo medically or with the help of vacuum aspiration.

ICD-10

O02.0 Dead gestational sac and non-vesical mole

• Anembryonic causes
• Pathogenesis
• Classification
• Anembryonic symptoms
• Complications
• Diagnostics
• Treatment of anembryonia
  • Medical treatment
  • Surgical treatment
  • Rehabilitation
• Prognosis and prevention
• Treatment prices

General

Anembryony, or non-vesical drift, may be the result of the initial absence of the embryo in the uterine cavity or its death in up to 5 weeks. In women with a diagnosed pregnancy, on average, one in five ends in spontaneous abortion or stops development. Self-emptying of the uterine cavity occurs in 53% within 2 weeks after diagnosed anembryony. If the remnants of the fetal egg are not removed during this period, then 2.5% experience bleeding or infectious and inflammatory complications that require curettage and subsequent treatment. A fertilized egg with anembryony can linger in the uterus for more than 2 weeks, however, symptoms appear that require surgical care.

Anembryony

Anembryonic causes

The exact causes of this pathology are difficult to establish, they are assumed retrospectively based on additional symptoms and examination of the woman. The cause of anembryony can be maternal diseases, as well as the action of various external and internal pathological factors. The main risk of pregnancy loss occurs at a short time, when the first division of blastomeres occurs, the implantation of the embryo into the uterine mucosa. The causes of anembryony may include the following disorders:

• Genetic and chromosomal abnormalities. They are the main cause of early pregnancy loss. Chromosomal abnormalities occur both at the stage of fertilization when two sperm enter the egg, and at the next stages of cell division. The older the mother, the higher the chance of chromosomal aberrations.
• pathology of the endometrium. The cause of anembryony can be chronic endometritis and the syndrome of regenerative plastic insufficiency of the endometrium. In chronic inflammation, immune changes occur that reduce the receptive properties of the mucous membrane, lead to slugging of erythrocytes in the forming chorionic villi and the formation of microthrombi.
• anatomical disorders. The prerequisite may be congenital malformations of the uterus or acquired structural changes that are caused by synechia, myomatous nodes, polyps. These pathologies are accompanied by signs of hormonal disorders, changes in the receptivity of the endometrium.
• Diseases of the coagulation system. Thrombophilia, which occurs against the background of antiphospholipid syndrome or insufficiency of hemostasis, leads to the formation of blood clots in the intervillous space. The nutrition of the embryo is disturbed, which causes its death at the beginning of pregnancy.

Anembryony is associated with the death of the embryo and a violation of the inertia of the uterus, which leads to a delay in the cavity of an empty fetal egg. The main causes of myometrial unresponsiveness are as follows:

• Tight attachment of the embryo. Deep invasion of chorionic villi occurs with structural and functional inferiority of the endometrium. Another reason is the incomplete pregravid transformation in the implantation zone and the high proliferative activity of chorionic villi.
• Immune deficiency. The tissues of the embryo are half alien to the mother's body, therefore, normally, with the participation of progesterone, suppression of immune rejection reactions occurs. The reasons for the preservation of the fetal egg during anembryony are associated with the immunological unreactivity of the myometrium to the products of conception.
• Impaired contractile function. Rejection of an empty egg does not occur in chronic inflammatory diseases of the uterus due to impaired formation of receptors for uterotonic substances. A common cause is biochemical metabolic defects in the tissues of the uterus.
• Folate deficiency. Folic acid is involved in the division of DNA in cells. With its deficiency in the early stages of pregnancy, there is a violation of the divergence of chromosomes, their incorrect arrangement. Also, with a lack of folate, sensitivity to radiation exposure increases.

Pathogenesis

On the 7-8th day after fertilization, the embryo implants into the uterine wall, the trophoblast actively produces hCG, which is necessary to maintain pregnancy. By the 3rd week of development, extraembryonic organs are formed in the embryo - the chorion, the yolk sac and the amnion. A little later, the heart begins to beat, but with the help of an ultrasound machine, this can be seen after the 5th week of gestation. If there is a violation of blood flow at the site of implantation, the embryo dies and is gradually reduced. But the fetal vesicle continues to be visualized under the influence of the remaining plume of high pregnancy hormones. In case of violation of uterine contractility, its rejection and expulsion does not occur.

Morphological examination of the endometrium after curettage in anembryonic shows that the decidual layer of cells is dystrophically changed. It often reveals lymphoid infiltration, focal edema of the stroma, dilated glands with flattened epithelial cells. Chorionic villi increase, the epithelium lining them becomes thinner and is located in one layer of synciotrophoblast. Cytotrophoblast is absent in places.

Classification

Anembryony is classified according to the results of an ultrasound examination, which allows you to determine the size of the fetal egg and its contents. The size of the uterus does not affect the type of anembryony, but is taken into account when determining the gestational age. There are two types of the absence of an embryo:

• 1 typ. The average diameter of the fetal egg is 2-2.5 cm, the embryo is not visualized. The size of the uterus corresponds to the 5-7th week of pregnancy, which does not correspond to the period on the first day of the last menstruation. Under dynamic observation, there is no increase in size.
• 2 typ. The fertilized egg continues to grow, but there is no embryo. Sometimes its remnants are observed in the form of a thin hyperechoic strip. Anembryony of this type can last up to 11 weeks, the egg reaches a size of 4.5-5 cm.

Anembryonic symptoms

With a normally developing pregnancy, by 5-6 weeks there are many signs of gestation: symptoms of toxicosis, engorgement of the mammary glands, drowsiness or insomnia, mood swings. During the formation of anembryony, a pregnant woman may notice that at some point she began to feel better, morning sickness disappeared, there is no aversion to odors and hypersalivation. Normal appetite is restored. Then the mammary glands lose soreness and hypersensitivity, become soft. But these signs may not always indicate anembryony. The same symptoms are typical for a missed pregnancy.

Complications

Women who do not turn to the gynecologist in a timely manner with signs of pregnancy or their disappearance may face serious complications. When an empty fetal vesicle remains in the uterus for up to 2 weeks or more, an inflammatory reaction occurs, symptoms of acute endometritis appear. The temperature rises, serous-mucous discharge appears from the vagina, signs of intoxication are disturbing - weakness, headache. In the absence of treatment or untimely onset, acute inflammation can move to the muscle layer, periuterine tissue, and in severe cases lead to peritonitis. If treatment is not carried out, chronic endometritis develops.

A sign of rejection of the remains of the embryo from the uterus is the appearance of bloody discharge from the genital tract. But with insufficient contractility of the uterus, violations of hemostasis, bleeding develops. It cannot end on its own, so medical attention is required. The consequence of bleeding is infection of the uterine cavity, anemia. Anembryony is complicated by subsequent habitual miscarriage, secondary infertility.

Diagnosis

Examination and choice of method of treatment for anembryonia is carried out by an obstetrician-gynecologist. Physical examination does not provide accurate information about the pathology, laboratory methods are also non-specific. The most accurate data can be obtained with vaginal ultrasound of the small pelvis. The survey algorithm includes:

• Gynecological examination. It is not always possible to notice signs of pathology, sometimes with a two-handed examination, a lag in the size of the uterus, its softening, can be determined. The accession of inflammation is characterized by the appearance of serous-sanitary secretions from the cervix.
• Laboratory studies. HCG in the blood falls 6-8 times lower than normal for gestational age. Alpha-fetoprotein increases by 1.5 times or more, but is not a sign of only anembryony, similar changes occur during missed pregnancy. The trophoblastic glycoprotein decreases by 6-18 times, which indicates the death of syncytiotrophoblast cells. The concentration of progesterone may remain at the same level, and estrogens decrease.
• Instrumental methods. Informative ultrasound with a vaginal probe. Signs of anembryony are a fetal egg of 25 mm or more and the absence of an embryo in it. If after 2 weeks a second ultrasound does not detect a heartbeat, then anembryony is diagnosed.

For a correct assessment of the results, ultrasound is carried out in dynamics. If the fetus does not have a heartbeat at 5 weeks, it cannot be unequivocally said that anembryony has been determined. The absence of a yolk sac is an unfavorable prognostic sign that is consistent with a possible anembryonic pregnancy.

Anembryonic treatment

Treatment is aimed at evacuating the remains of the fetal egg from the uterine cavity. This can be done medically and surgically. The latter is used more often, but it is associated with an additional risk of infection and complications. WHO recommends medical abortion as the primary treatment for anembryonia.

Medical treatment

Medical interruption of gestation is carried out with symptoms of anembryonia up to 83 days of pregnancy. Mifepristone and misoprostol are used sequentially for the procedure. The dosage of the latter is selected individually and depends on the gestational age for the last menstruation. Bleeding, which means the release of the remains of the embryo, occurs on the second day. A woman should come to the appointment 14 days after taking the last pill to assess the general condition and effectiveness of the procedure.

Medical abortion has few contraindications. It can be used for infections of the genital tract without prior sanitation. The method is not recommended for bronchial asthma, the presence of pathologies of the cardiovascular system, blood clotting disorders and in women who smoke. Complications of medical abortion may include pain, bleeding, and incomplete abortion, which will require the use of surgical methods.

Surgical treatment

Vacuum aspiration is considered the best and least traumatic method among surgical methods. With anembryony, it can be used up to 12 weeks of pregnancy, because. the fertilized egg remains small. Before the procedure, it is necessary to examine the smear for the degree of purity of the vagina. With signs of inflammation, sanitation is carried out with local means. Vacuum aspiration is performed on an outpatient basis, hospitalization in the gynecology department is not required. After the procedure, there is a possibility of infectious complications, bleeding and preservation of the remains of embryonic tissues, which may require curettage.

For curettage of the uterine cavity, a woman is hospitalized in the gynecological department after a preliminary examination. The procedure is performed under general anesthesia and requires medical supervision for several days after it. In the postoperative period, antibiotic prophylaxis is mandatory to reduce the risk of infectious complications, uterotonics to improve uterine contractility.

Rehabilitation

A single case of anembryony is not dangerous, but if it is repeated or another type of interruption of gestation for a short period, a thorough examination and rehabilitation is necessary. Most women have severe symptoms of chronic endometritis or its latent course is observed. Therefore, broad-spectrum antibiotics are prescribed.

To correct metabolic and functional disorders in the endometrium, anti-inflammatory drugs, enzymes, immunomodulators are used, courses of physiotherapy are prescribed. Combined oral contraceptives are used to restore hormonal regulation within 3-6 months. Planning a new pregnancy is carried out after careful preconception preparation.

Prognosis and prevention

For the life of a woman and the subsequent implementation of the reproductive function, the prognosis is favorable. After the restoration of the endometrium and the elimination of possible causes of the pathology, conception can be planned. To prevent anembryonia, it is necessary to beware of the action of external adverse factors, to avoid the use of toxic substances, alcohol, and smoking. If sexually transmitted infections are suspected, they should be treated promptly. Women 2 months before conception should start taking folic acid and continue the course until the end of the first trimester.

You can share your medical history, what helped you in the treatment of anembryony.

Sources

1. Undeveloped pregnancy.

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