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Anembryony - pregnancy or not?

Unfortunately, not all pregnancies end in childbearing. Reproductive losses in this case can be due to various reasons. And one of them is a non-developing or missed pregnancy. The proportion of this pathology accounts for up to 15-20% of reproductive losses. Currently, there are 2 variants of missed pregnancy: death of the embryo and anembryony. It is important to understand that the differential diagnosis between them does not affect the subsequent treatment tactics, but is taken into account when assessing the prognosis. Anembryony is more often determined, and this condition in many cases is not accompanied by spontaneous abortion and therefore requires artificial termination of a missed pregnancy. nine0005

Anembryony – what is it?

Anembryony - is the absence of an embryo in a developing fetal egg. This condition is also called the empty gestational sac syndrome. This is by no means a rare pathology that can be diagnosed in primigravida and in women who already have healthy children.

Many possible causes of anembryony have now been identified. These include:

• Genetic anomalies , which are observed in almost 80% of the pathological condition. They are usually associated with gross and/or multiple chromosomal abnormalities. Moreover, with anembryony, such anomalies are of a qualitative nature, and with the death of the embryo and its abortion, they are predominantly quantitative. Unviable combinations of parental genes or mutations in key areas responsible for the early stages of embryogenesis and the synthesis of the main structural proteins of cell membranes are also possible. nine0020
• Some acute viral and bacterial diseases occurring in early pregnancy and leading to damage to embryonic tissues or trophoblast. The most dangerous in this regard are TORCH infections, although other pathogens can also be embryotropic.
• Persistent viral-bacterial infections of the organs of the reproductive system, leading to the development of chronic endometritis . And in most cases, such a pathology occurs without obvious clinical symptoms and is detected after a frozen pregnancy. nine0020
• Radiation exposure of to a developing embryo.
• Exogenous intoxications : taking drugs with embryotoxic action, drug addiction, exposure to certain industrial and agricultural poisons (toxins).
• Endocrine disorders in a pregnant woman. And the most critical is the deficiency of progesterone and disorders of its metabolism, which is the main cause of the pathology of endometrial decidualization and abnormal implantation of the fetal egg. nine0020

In general, the causes of pathology in most cases remain undiagnosed. Usually it is possible to determine only a presumptive etiology.

Genetic diagnosis of aborted tissues can reveal obvious anomalies of hereditary material. But such a study, unfortunately, is carried out in a very small percentage of cases. Basically, it is indicated with a burdened obstetric history in a woman, when she already had frozen or spontaneously interrupted in the early stages of gestation in the past. But even such a diagnosis is not always informative enough, which is associated with the limited possibilities of modern genetics and the high probability of the impact of other etiological factors. nine0005

Pathogenesis

Anembryony is a consequence of the cessation of reproduction and differentiation of the embryoblast or inner cell mass - a group of cells that normally give rise to fetal tissues. And this happens at the earliest stages of pregnancy (usually at 2-4 weeks of gestation), and without disturbing the development of the fetal membranes from the trophoblast. As a result, a so-called empty fetal egg is formed, which continues to grow even in the absence of an embryo in it.

Pathogenetically important factors in the development of the disease include:

• Inherited or acquired chromosome aberrations and other genetic abnormalities. They can lead to a gross desynchronization of the development of embryonic tissues, critical changes in the structure of collagen and other proteins, disruption of the induction of differentiation and migration of dividing cells. The most common autosomal trisomy, monosomy, triploidy, tetraploidy.
• Excessive formation of circulating immune complexes in a woman's body . Their deposition in the walls of small vessels leads to thromboembolism and other critical microcirculation disorders in the area of ​​the implanting egg. Antiphospholipid antibodies are of the greatest clinical importance.
• Excessive activation of T-helpers with an increase in the concentration and aggression of the cytokines secreted by them. These substances are able to have a direct and indirect damaging effect on embryonic tissues with a violation of their proliferation and differentiation. In fact, the fetal egg in this case acts as a target for the cellular link of immunity. The reason for such an abnormal immune response of a woman's body may be a chronic infection of the endometrium, hormonal abnormalities, and some other endogenous factors. nine0020

It is important to understand that with anembryony in the body of a woman, substances are produced that contribute to the prolongation of pregnancy. Therefore, in a significant proportion of cases, spontaneous abortion does not occur. The patient develops and maintains signs of pregnancy, there is an increase in hCG in the blood serum. Therefore, the basal temperature during anembryony usually does not have characteristic features. And on the first early ultrasound, the fact of successful implantation of the fetal egg in the uterine cavity is confirmed. After all, pregnancy does occur, but it develops without a key component - the embryo. nine0005

In the future, rejection of the abnormal fetal egg is possible. In this case, the threat of termination of pregnancy (including with the formation of exfoliating retrochorial hematomas) or spontaneous abortion (miscarriage) can be diagnosed. But often anembryony is diagnosed only during a routine examination, in which case the diagnosis is absolutely unexpected and shocking news. Such a pregnancy requires an artificial interruption.

How does this manifest itself?

Anembryony does not have its own clinical symptoms , all emerging disorders are usually associated with the threat of termination of such a pathological pregnancy. And the warning signs include the presence of clinical manifestations of relative progesterone deficiency, which creates the prerequisites for spontaneous abortion. Therefore, pain in the lower abdomen and bloody discharge can become a reason for contacting a doctor; with anembryony, they can appear at almost any time during the 1st trimester. But often a woman learns about the existing pathology only when conducting a screening ultrasound for a period of 10-14 weeks. nine0005

Diagnosis

Like other forms of miscarriage, anembryony is detected in the first trimester of gestation. And the main diagnostic tool in this case is ultrasound , because it is this study that allows you to visualize the existing deviations.

At the same time, symptoms can be reliably detected only after the 8th week of gestation. At earlier dates, visualization is often insufficient due to the too small size of the ovum, so an erroneous diagnosis is not ruled out. Therefore If a missed pregnancy and anembryony are suspected, it is recommended to conduct an examination several times, repeating the procedure on expert-class equipment with an interval of 6-8 days. At the same time, the initial diagnosis of an empty fetal egg can be removed if subsequent ultrasound scans can visualize an embryo with signs of a heartbeat and sufficient developmental dynamics.

The main echographic features:

• absence of the yolk sac when the diameter of the fetal egg is 8-25 mm; nine0020
• absence of an embryo in a fetal egg with a diameter of more than 25 mm.

Additional signs of a missed pregnancy include an irregular shape of the fetal egg, an insufficient increase in its diameter in dynamics, a weak severity of the decidual reaction, and the absence of a heartbeat at a gestational age of 7 or more weeks. And signs of the threat of its interruption are a change in the tone of the uterus and the appearance of areas of chorion detachment with the appearance of subchorial hematomas.

Anembryony can also be suspected by a dynamic assessment of the level of hCG in the blood. An increase in the level of this hormone along the lower limit of the norm should be the basis for further examination of a woman with an ultrasound scan. It is important to understand that hCG is also produced in the syndrome of an empty ovum. Moreover, its level in this pathology will be almost normal, in contrast to a frozen pregnancy with the death of a normally developing embryo. Therefore, monitoring of indirect signs of pregnancy and the growth of hCG during anembryony cannot be attributed to reliable diagnostic methods. nine0005

Varieties

Several variants of the empty ovum syndrome are possible:

• Type I anembryony. The embryo and its remains are not visualized, the size of the fetal egg and uterus does not correspond to the expected gestational age. The diameter of the egg is usually no more than 2.5 mm, and the uterus is enlarged only up to 5-7 weeks of gestation.
• Type II anembryony. There is no embryo, but the fetal egg and uterus correspond to the gestational age. nine0020
• Resorption of one or more embryos in multiple pregnancies. At the same time, normally developing and regressing fetal eggs are visualized. According to this type, anembryony often occurs after IVF, if several embryos were implanted in a woman.

All these varieties are determined only with the help of ultrasound, they do not have characteristic clinical features .

What to do?

Confirmed anembryony is an indication for abortion. This does not take into account the gestational age, the woman's well-being and the presence of signs of a possible spontaneous abortion. An exception is the situation when the anembryony of the second fetal egg is diagnosed in a multiple pregnancy. In this case, a wait-and-see strategy is taken, evaluating the dynamics of the development of the preserved embryo. nine0005

Termination of a missed pregnancy is carried out only in a hospital. After the procedure for the evacuation of the fetal egg, the woman should be under medical supervision. In many cases, after it, additional medication and sometimes physiotherapy are prescribed, aimed at normalizing the hormonal background, preventing inflammatory and hemorrhagic complications, and eliminating the detected infection.

Several techniques can be used to perform a medical abortion for this pathology. Can be used:

• medical abortion - termination of pregnancy with the help of hormonal drugs that provoke rejection of the endometrium along with an implanted fetal egg;
• vacuum aspiration of the contents of the uterine cavity;
• curettage is an operation involving the mechanical removal of the fetal egg and endometrium with a special instrument (curette) after the forced expansion of the cervical canal with bougie.

Medical abortion for anembryos is possible only for a period of 6-8 weeks. In later periods of gestation, preference is given to mechanical methods, which requires the use of general anesthesia. The choice of the method of artificial abortion depends on whether the stomach hurts after an abortion, the length of the rehabilitation period, the likelihood of early and late complications. nine0005

Examination after induced abortion necessarily includes ultrasound control. This allows you to confirm the complete evacuation of the membranes and endometrium, to exclude undesirable consequences of abortion in the form of hematomas, perforation and endometritis.

Prediction

Can anembryony recur? Can I still have children? These questions concern all patients who have undergone this pathology. Fortunately, in most cases, the condition does not recur, the woman subsequently manages to safely become pregnant and bear the child. But at the same time, she is classified as a risk group for the possible development of complications of pregnancy and childbirth. Therefore, in the first trimester, she is usually assigned dynamic ultrasound control of the development of the fetal egg, determination of the hormonal profile and assessment of the state of the hemostasis system. nine0005

Pregnancy after anembryos is theoretically possible already in the next ovarian-menstrual cycle. But it is desirable to let the body recover. Therefore, it is recommended to start planning for re-conception not earlier than 3 months after the induced abortion . If it proceeded with complications, the rehabilitation period, while maintaining reproductive rest, is extended for up to six months. If a woman has chronic endometritis and various infections, 2 months after the completion of treatment, a control examination is carried out and only then the possible timing of re-conception is determined. nine0005

Barrier method and hormonal contraception are preferred to prevent pregnancy. The selection of funds in this case is carried out individually. Intrauterine devices immediately after a frozen pregnancy are not used in order to avoid the development of endometritis.

Prevention

Primary prevention of anembryonia includes careful planning of pregnancy with a comprehensive examination. If deviations are found, they are corrected. Of course, such preparation does not allow 100% to exclude the possibility of pathology, but reduces the risk of its development. nine0005

Secondary prophylaxis is carried out if the woman has a history of spontaneous abortions and anembryos. The first pregnancy with empty ovum syndrome is a reason for a subsequent examination of a woman for infections and hemostasis disorders. When the situation repeats, a genetic examination of the spouses is also shown to exclude anomalies in their hereditary material. In some cases, subsequent conception is preferably carried out using IVF, which will allow the use of preimplantation diagnosis to detect chromosomal abnormalities in embryos. nine0005

Anembryony is diagnosed quite often. And, unfortunately, at present it is not yet possible to completely exclude such a pathology already at the stage of pregnancy planning. After all, it can develop even in completely healthy and examined patients. At the same time, a missed missed pregnancy does not mean the impossibility of a repeated successful conception; most women after anembryony manage to safely give birth to a healthy child.

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. nine0005

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. nine0005

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. nine0020
• Virus, infection, inflammation. A bacterial or viral infection, as well as an inflammatory process in any part of the female body, can cause an arrest in 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. nine0020
• Hormonal causes. Any disturbances and failures 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. nine0005

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.

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