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Dignosed with a blightem ovum. Scheduled for D&C. What could be the reason for miscarriage?

Mar 2013
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Practicing since : 1998
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helllo, I have been dignosed with a blightem ovum. On 5.21 had a songram - sac was present - 5 weeks 2 days, 10 days later, sono showed 5 weeks, 6 days no yolk sac. My doctor diagonsed me with a blightem ovum with a D&C scheduled the week of the 18th. How long does it take to mioscarry. I know all vary but is there an average. Also have you seen misdiagnosis in these instraces
Posted Fri, 28 Jun 2013 in Pregnancy
Answered by Dr. Aarti Abraham 17 minutes later
Thanks for your query.
A blighted ovum is a type of pregnancy loss which happens in very early pregnancy.

After conception, the fertilized egg (ovum) implants in your uterus (womb), but for some reason a baby does not develop. It can happen to anyone. It usually happens accidentally, and most women go on to have a successful pregnancy next time.

You may feel your pregnancy is progressing normally, because you have not felt any pain or experienced bleeding. Your body may still be giving you all the signals that you are pregnant, although if your hormone levels are falling, those signs may lessen slightly. Your breasts may feel less tender, for example.

Often, the first time you are aware anything is wrong is when you have your first ultrasound and are told that the pregnancy sac which would normally contain an embryo is empty.

If, like most women in this situation, you had no idea that your pregnancy wasn't progressing well until your ultrasound, the news will have come as a great shock. It can be hard to understand or accept, and you will need time to come to terms with it.

We don't fully understand why a blighted ovum happens, but it's thought to be an accident of nature. When an egg is fertilized by a sperm, the cells begin dividing. Some cells develop into the embryo, and others develop into the placenta and membranes.

Sometimes, the cells that would have become the embryo fail (probably because a mistake happened during fertilization, and there are too many or too few chromosomes), but the cells that become the placenta and membranes keep developing, so the pregnancy sac continues to grow inside the uterus and the placenta starts to form.

Your body doesn’t recognize that there is no baby developing inside the sac, because pregnancy hormones are still being produced which prevent a miscarriage.

During a vaginal ultrasound, if the average gestational sac diameter is more than eight millimeters without a yolk sac or if the average gestational sac diameter is over 16mm without an embryo, then your sonographer can make a diagnosis of a missed or silent miscarriage. If you have a abdominal ultrasound then the gestational sac must be bigger than 20mm without a yolk sac or 25 mm without an embryo. Since these measurements are so small and sometimes difficult to confirm, you may be asked to come back in a week for another vaginal ultrasound.

It's safe to wait to miscarry naturally when the pregnancy hormones eventually fall, but this can take many weeks. If you have had some bleeding, it may be worth waiting to see if nature will take care of things.

If you are totally asymptomatic, ( no bleeding / pain with cramping / no dilatation of the cervix on examination ), doctors prefer not to wait, as complications such as infection might set in. Medical abortion maybe tried, which has a 15 = 20 % failure rate. If this medicinal approach does not work, then you may need a minor surgery called a D&C (dilation and curettage) that will remove the lining of your uterus. This is carried out under a general anesthetic, normally as a day procedure.

Most doctors prefer a D and C straightaway because with medical abortion, you might spot / bleed / be in pain for a long period lasting for days/

Once the miscarriage happens, your periods will start again. You might want to wait a couple of months just to give your body a rest, and to feel emotionally ready, before trying again for a baby.

You will naturally be very anxious that you may have a miscarriage again. However, most women go on to have a successful pregnancy the next time and an early ultrasound may be recommended to reassure you. Once a heartbeat has been seen, the pregnancy is said to be viable and the chance of a successful outcome is much better.

Regarding a misdiagnosis, please mention the date of your last period, and your normal menstrual cycles. Also, any previous obstetric history if any.
That will help me to comment whether there is any scope for misdiagnosis in your condition.
It would help to know the exact size of the sac measured in the scans too.

Hope this clarifies matters.
All the best.
Above answer was peer-reviewed by
Follow-up: Dignosed with a blightem ovum. Scheduled for D&C. What could be the reason for miscarriage? 13 hours later
Thank you. My last period was may 9th and prior to that april 9th and before that march 12th, however I got off birth control in march so prior to that I was on a 28 cycle due to bc.
My first sono was on may 16th and we did not see anything, may 21st we saw a sac measuring 5 weeks 2 days, may 31st saw a sac measuring 5 weeks 6 days. We did not see a yolk sac either time.
As for medical history, the only issue I had was having to get a leep twice due to admiral Pap smears abt 4-5 years ago.
Answered by Dr. Aarti Abraham 1 hour later
Did you have a proper period on 9th of May ?
If so, why was a sonogram done on 16th of May , because it was way too early to suspect a pregnancy, just a week after your period ???
Please clarify.
Above answer was peer-reviewed by
Follow-up: Dignosed with a blightem ovum. Scheduled for D&C. What could be the reason for miscarriage? 2 hours later
Apologies I did not have a period may 9th.. My last period was April 9th and before that march 12th and before that I was on birth control. I did NOT have period on may 9th. The reason I went in for a sono on may 16 was due to brown spotting.
Answered by Dr. Aarti Abraham 2 hours later
Going by the date of your last period, on May 16th you were 5 wk 2 days and the ultrasound corresponded.
On 31st of May, you should have been 7 wk 2 days, and the scan showed no growth. Hence, I do not think there is any room for misdiagnosis here.
In early pregnancy, the yolk sac functions as a source of nourishment for the developing baby before ultimately being absorbed by the baby as a part of the gut. The yolk sac is the first thing to become visible inside the gestational sac on a transvaginal ultrasound, appearing at an average of 5.5 to 6 weeks' gestational age.

When an ultrasound shows no yolk sac, the reason may be miscarriage but it could also be that the pregnancy is still early.

Because the yolk sac first becomes visible around 5.5 weeks of gestation, seeing no yolk sac on an ultrasound could simply mean that the pregnancy is not yet 5.5 weeks along -- and errors in remembering the last menstrual period or irregular cycles can affect calculations of how far along a pregnancy is at the time of an ultrasound. This was not the case with you. When doctors suspect incorrect dates as a possibility, they will recommend a second ultrasound. In a viable pregnancy, the yolk sac and possibly the fetal pole will always become visible on a followup ultrasound.

Seeing no yolk sac can also be a sign of miscarriage. When a followup ultrasound does not show continued development and the appearance of a yolk sac, a doctor will diagnose miscarriage. Research suggests that a gestational sac larger than 13 mm that contains no yolk sac means the pregnancy is not viable, so when the sac is larger than this and there is no yolk sac, the doctor can diagnose miscarriage based on a single ultrasound. Most often, a miscarriage that consists of no yolk sac would fall in the category of blighted ovum.

Unfortunately when you are faced with an ultrasound that shows no yolk sac, you will probably be told to wait for a followup ultrasound. The wait can be very difficult, naturally, but is necessary for an accurate diagnosis.

In your case, this is definitely a blighted ovum , and termination is the correct option for you.

Above answer was peer-reviewed by
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