What Is a Blighted Ovum? (original) (raw)

With a blighted ovum, an egg is fertilized, prompting the body to pave the way for a baby by pumping out pregnancy hormones and forming the gestational sac and placenta. For some reason, though, the developmental process gets disrupted and the fertilized egg never develops into an embryo, leaving a fully formed gestational sac and potentially all the symptoms of pregnancy—but no developing embryo.

What Is a Blighted Ovum?

Blighted ovum is a term used to explain an empty gestational sac. This type of pregnancy is also called anembryonic pregnancy because while the gestational sac releases pregnancy hormones, no embryo forms. Blighted ovum pregnancies always end in miscarriage, usually early in the first trimester.

Read on to learn more about blighted ovum causes, signs, and treatment.

Causes of Blighted Ovum

A blighted ovum may result from a poor-quality sperm or egg, or it may occur due to abnormal cell division. But in many cases, an anembryonic pregnancy is caused by a chromosomal abnormality, says Octavia Cannon, D.O., an OB-GYN with Alliance Obstetrics & Gynecology in East Lansing, Michigan. There isn't always a clear explanation, but blighted ova are not caused by anything the biological parents did before or after conception.

How Common Is a Blighted Ovum?

Blighted ova are quite common. Dr. Cannon notes that blighted ovum is the cause behind a staggering 50% of first-trimester miscarriages. And considering that 10% to 20% of all known pregnancies end in miscarriage—and more than 80% happen in the first trimester—that's not a small number.

Blighted Ovum Symptoms

If the blighted ovum results in a very early miscarriage, you may not even know you were pregnant. Other times, the pregnancy continues long enough that you get a positive pregnancy test and even experience some early pregnancy symptoms.

Because of the nature of anembryonic pregnancy, symptoms of a blighted ovum can include both early pregnancy symptoms (such as a missed period, positive pregnancy test, breast tenderness, and even morning sickness) and symptoms of early miscarriage (such as abdominal cramping and vaginal bleeding).

Prior to your first ultrasound, you may be unaware that you have a blighted ovum since the empty gestational sac and placenta continue to give off hormones that make your body think it's pregnant. When an embryo doesn't form and the level of those hormones eventually begins to drop, however, pregnancy symptoms may fade and you may experience signs of miscarriage.

Blighted Ovum Ultrasound and Diagnosis

The only way to confirm a blighted ovum is through ultrasound. In fact, many people learn about a blighted ovum during the first-trimester ultrasound. Others might experience heavy period-like bleeding and cramping, the most common signs of miscarriage, before the blighted ovum is detected.

An ultrasound that shows an empty and often smaller-than-expected gestational sac will confirm a blighted ovum diagnosis. In the case of very early pregnancy, a health care provider might suspect a blighted ovum but advise you to wait a week and do a repeat ultrasound to ensure no embryo has formed. Lower-than-expected or dropping levels of human chorionic gonadotropin (hCG), the pregnancy hormone produced by the placenta, can also indicate miscarriage but a health care provider will not diagnose blighted ovum using hCG levels alone.

In rare cases, an anembryonic pregnancy can also be ectopic, meaning that the fertilized egg implants somewhere other than the uterus, most commonly in a fallopian tube. But the two conditions are not linked; most blighted ova are not ectopic pregnancies, nor are most ectopic pregnancies anembryonic. Like a blighted ovum in the uterus, an ectopic blighted ovum is also diagnosed by ultrasound.

Blighted Ovum Treatment

An anembryonic pregnancy will be treated differently for every person, depending on the situation. Many people with a blighted ovum will miscarry naturally at home without intervention. However, some people's bodies need help with completing the miscarriage. After receiving the diagnosis, a health care provider may talk to you about the following options:

• Expectant management: Expectant management is essentially a wait-and-see approach. If the health care provider believes that it's safe to wait, you may choose to see if your body naturally releases the pregnancy. If you have already begun to experience miscarriage-related cramping and bleeding (and ectopic pregnancy has been ruled out), you will likely be given the opportunity to wait it out at home.
• Medication: If your body has not naturally released the pregnancy tissues or it's not safe to wait, you and your health care provider may opt for inducing the miscarriage with a medication called misoprostol, which triggers the body to release the contents of the uterus, typically within several hours. Adding mifepristone to misoprostol makes medication treatment even more effective.
• Dilation and curettage (D&C): A D&C is a surgical procedure typically done under sedation or general anesthesia that clears the contents of the uterus using surgical tools, removing the products of the pregnancy. If you are very early on, a D&C can be done in the office with local anesthetic, a procedure that is commonly known as a manual vacuum aspiration

No matter what process you and the health care provider choose, you will likely have a follow-up appointment four to six weeks after the process is complete. Your provider will confirm that the miscarriage is complete by asking about your clinical symptoms, and sometimes they may even offer you pregnancy hormone testing or an ultrasound if the clinical symptoms are not clear.

The provider may order follow-up blood tests to track your hCG levels. With a blighted ovum, your hCG levels may increase when your body thinks it's pregnant, but they'll eventually begin to fall. Soon enough, your blighted ovum hCG levels will return to their pre-pregnancy state.

An important thing to note: If you miscarry at home either naturally or with medication, you won't see an embryo or anything that resembles a baby. Some may see a formed sac, but more likely, the products of the pregnancy will only look like blood, blood clots, mucus, and thick tissue.

While some will take comfort in the knowledge that they won't pass a formed embryo, others might struggle with never seeing physical "evidence" of the pregnancy and may need other physical signs of closure as they move through their grieving process.

Can You Prevent a Blighted Ovum?

There is nothing you can do to prevent a blighted ovum, which also means that a blighted ovum is not your fault. However, if you or a health care provider suspect genetic issues may be a factor, you may want to request genetic testing to see if there could be an underlying issue.

Dr. Cannon explains that whether a blighted ovum diagnosis is confirmed for a first pregnancy or after you've already had a healthy baby, it should not be cause for worry. "Many times, a patient will have already had a normal pregnancy and then have a blighted ovum," she says. "If it happens more than once consecutively, I urge the patient to allow additional testing to try to find a reason for the recurrent miscarriage."

Healing From a Blighted Ovum Miscarriage

Healing from a blighted ovum is essentially the same as recovery from all types of early miscarriage.

Physical recovery

You can expect abdominal cramping for up to a week after passing the pregnancy, while vaginal bleeding and eventually spotting can last several weeks. While you can usually get back to your usual routines within a couple of days, you may notice that the bleeding increases with physical exercise.

Dr. Cannon recommends that those healing after a miscarriage continue taking their prenatal vitamins and abstain from putting anything in the vagina (including fingers, penises, sex toys, douches, tampons, and other internal period products) for at least a month, no matter if the tissue was passed surgically, medically, or naturally. You can expect the return of your menstrual cycle in about one month, and the initial cycle may be heavier than usual.

Emotional recovery

While physical recovery from an early pregnancy loss with a blighted ovum is commonly quick, the emotional healing can be a longer, more difficult journey. With a blighted ovum, it's especially important to realize that you have every right to acknowledge the full weight of your loss.

"I always stress to my patients that although there was no embryo, it was still a pregnancy," Dr. Cannon explains. It is a loss, and you have every right to grieve.

She also notes that some people can experience postpartum depression after a pregnancy loss, so it's essential to be aware of the symptoms and to talk openly and honestly with a support person who can monitor for any signs of postpartum depression as well.

Getting Pregnant After a Blighted Ovum

Many doctors used to advise people to wait for two to three menstrual cycles after a miscarriage before trying to conceive again. Still, newer recommendations from the American College of Obstetricians and Gynecologists (ACOG) cite the lack of evidence that delaying conception after miscarriage has any benefits.

So you can try to conceive again as soon as you feel comfortable, although you may want to wait until after you've had at least one menstrual period, so calculating the due date of a subsequent pregnancy is easier and you reduce the risk of getting a false positive pregnancy test.

A person's chances of having another anembryonic pregnancy are low, and many people go on to have healthy, full-term pregnancies after a blighted ovum should they choose. In those very rare cases of recurrent miscarriage (that is having two or more consecutive pregnancy losses), a health care provider may suggest additional testing to try to determine whether there is an underlying cause.

Key Takeaway

Early pregnancy loss is very common but can also be very difficult—and an anembryonic pregnancy is no different. As with other types of miscarriage, people who experience a blighted ovum often need time to heal physically and emotionally. Experiencing a blighted ovum generally will not impact future pregnancies, so if a person wishes to become pregnant again, their odds of having a healthy, full-term pregnancy are typically the same as before the loss.