The Diagnosis of a Blighted Ovum

After having been diagnosed with a blighted ovum a few weeks after finding out we were pregnant, I learned a lot about it and here are some of them:

A blighted ovum ( also called an “anembryonic pregnancy”) is a fertilized egg which implants in the uterus, and begins to develop a gestational sac. The fertilized egg, however, fails to form beyond the sixth week and is absorbed back into the uterus. The placenta continues to grow, and the body is usually slow to catch on that the pregnancy is gone.

blighted ovum

There may be no bleeding to signal a problem; later, the woman may notice a brown discharge. Sometimes a woman will have a loss without ever knowing she was pregnant. Others will discover the pregnancy and all will appear well throughout much if not all of the first trimester. She may not realize she has a blighted ovum until her healthcare provider fails to detect a heartbeat or an ultrasound reveals an empty gestational sac. Since the placental tissue generates the making of pregnancy hormones, many women with a blighted ovum “feel pregnant” but are destined to lose the pregnancy. In past decades, many women miscarried blighted ovum pregnancies without knowing what had happened. Today, however, technology has improved to the point that an ultrasound can examine exactly what is going on inside the womb. Due to this technology, the diagnosis of a Blighted Ovum is becoming more common.

In most likelihood the reason is random chromosomal accident (further research suggests a 4 in 5 chance that the cause is chromosomal in this situation). In some cases, the egg or the sperm may be of poor quality. The age of the parents may contribute to this factor although this diagnosis happens to all ages. Occasionally the cause may be something other than chromosomal, such as low hormone levels. This is rare but in these cases a treatable condition might be the cause. For example, a low hormone level may have caused early termination of the pregnancy. In these cases, hormone pills such as progesterone may work. If repeated blighted ovums occur, artificial fertilization may be an answer. Genetic testing in the case of multiple losses may be advised to rule out genetic problems.

The most common (and hurtful) misconception is that there never was a baby. There was an embryo. There is no way to know how much of the baby formed and when the baby was absorbed. Someone actually suggested to me that my body was confused and that my little one only existed in my mind. Obviously there was something wrong with him or her and that is the reason she stopped forming. To suggest that he or she never existed at all, even for a moment, in my opinion devalues the little life that could have been. It also devalues all of the pain that we feel when we find out that the baby is gone. Just because the little angel is gone by the time the loss is discovered doesn’t mean that he or she never was. The body has reacted to the existance of that little one–however brief his or her presence was.

When should the baby be able to be seen by ultrasound, or when should the lack of seeing a baby via transvaginal ultrasound be evidence of a blighted ovum? By the 8th to the 9th week, assuming the pregnancy is dated correctly, the baby/heartbeat should be able to be detected via ultrasound. The gestational sac can be visualized as early as four and a half weeks of gestation and the yolk sac at about five weeks. The embryo can be observed and measured as early as five and a half weeks, via transvaginal ultrasound with a full bladder. Ultrasound can also very importantly confirm the site of the pregnancy is within the cavity of the uterus.

Hormone levels may be monitored in order to check on the pregnancy. Human chorionic gonadotropin (hCG), is produced during pregnancy, made by cells that form the placenta. They can first be detected by a normal blood test about 11 days after conception and at about 12 – 14 days by a urine test. In general they will double every 72 hours. The levels will reach their peak in the 8 – 11 weeks of pregnancy (the third month) and then will decline and level off for the remainder of the pregnancy. A decline early on might aid in confirming a pregancy loss, such as a blighted ovum.

During my research I read that “most” women in this situation expel (miscarry) the egg without any difficulty right away. It is my personal belief this is not necessarily true, as I have read a large number of posting within discussion boards where a large number of woman have told their story of how they failed to miscarry in the case of a blighted ovum. There are also many others, like me, who began to miscarry toward the end of the first trimester. A D and C might be needed to cleanse the body of the products of pregnancy.

There are many conflicting discussions about the choice of waiting to miscarry, allowing a natural miscarriage, and having a D&C done. I have two RNs in my family, and both disagree as to which is the best way to go. I chose to have a D&C, despite having a natural miscarriage. Once the Doctor told me that they could do another U/s and try to tell if there is still tissue left. She inspected the tissue I had gathered, stated it was not much, and told me that even if an U/s is done, it is still a Doctors best guess as to whether or not there is tissue left so I opted for the D&C with an official diagnosis of “incomplete miscarriage”. I am glad I chose this root, as it was both mentally and physically therapeutic–giving me the closure I needed in this situation. It is a personal choice, however, as there are risks with D&C. I was told by my Doctor that in 3% of all operations the uterus lining is perforated by the scalpel and the uterus may then grow together–leaving no cavity in which the baby can grow. The bowels also sit directly above the uterus. It is important to remember, however, that the odds of this happening are very low.

One’s mind naturally moves to a point where a woman wonders, “will this happen again?” It has also been reported that a blighted ovum does not increase the risk of future miscarriage. The standard statistics vary, but my research indicates a 80-85% chance that the next pregancy should carry to term. This seems to conflict with the varying stats for miscarriage, which are usually somewhere around 50% of all pregnant women miscarry. One must take into account, however, that many of those who miscarry do not even know they were pregnant–as a miscarriage takes place around the time the individual would usually menstruate. The 80-85% statistical number would then work when used on diagnoses pregnancies–pregnancies lasting long enough to test positive for the pregnancy hormones.

I was told that my life was forever changed by this occurance–and it is true. No one should have to experience the kind of pain that goes with such a loss. One moment there is a world of opportunities, with plans and hopes and dreams. Suddenly, they are all gone. It feels so unfair.

This posting was found by a friend on a medical forum, regarding this diagnosis:

A loss was most likely a chromosomal error if…

The fetus failed very early. For example, blighted ovums are pregnancy failures in which the fetus never develops. These occur before six-and-a-half weeks and about 90 percent of them are chromosomal errors.

A long time goes by between the failure of the fetus and the failure of the pregnancy. For example, let’s say you had a blighted ovum but your pregnancy was perceived to be clinically normal at twelve weeks. (The placenta can continue to grow and support itself without a baby for up to two months and, therefore, pregnancy hormone levels will continue to rise.) The fact that a placenta was chugging along without a baby on board speaks for adequacy of the uterine environment and adequacy of placental growth and development.

However, if a heartbeat was documented for your baby at seven weeks and you lose your pregnancy at seven weeks and two days, that starts making it less likely that it’s a random wrong chromosome number accident. The shorter the death to loss interval, the more likely it is that other factors contributed to the pregnancy loss.

Support group in forum format found at
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The Diagnosis of a Blighted Ovum

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