Get the facts about this very common type of miscarriage in the first trimester.
When I started bleeding a little after seven weeks into my pregnancy, I had never heard of a blighted ovum—but I knew right away that something was wrong.
Despite the fact that vaginal bleeding during the first trimester of a pregnancy can actually be normal and mightnot be a cause for concern, as my bleeding increased, so did my fear that I was going to miscarry. And when I finally went to the doctor a few days later, my fears were confirmed when the midwife informed me that I should prepare to lose the pregnancy. Part of me expected to hear those heartbreaking words, but I was not prepared by what she told me next—that she could not find my baby.
My midwife explained that I was showing signs of an anembryonic pregnancy, which meant that although my body for all intents and purposes was pregnant, I was actually pregnant without a baby. I was experiencing a type of loss called a blighted ovum.
Before it happened to me, I had no idea that a woman could be pregnant without a baby, but this is actually a very common cause of miscarriage in the first trimester.
What is a blighted ovum?
A blighted ovum, explains Octavia Cannon, D.O., an OB/GYN with Arboretum Obstetrics &Gynecology in Charlotte, North Carolina, is a term to explain an empty gestational sac. This type of pregnancy can also be called an anembryonic pregnancy because a woman is fully pregnant but without an actual embryo. An egg is fertilized, prompting the body to pave the way for a baby by pumping out pregnancy hormones and forming the gestational sac, but for some reason, the egg never develops into an embryo. This leaves the woman with a fully formed gestational sac, all the symptoms of pregnancy—such as a positive pregnancy test, missed period, morning sickness and sore breasts—but no developing embryo.
What causes it?
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, Dr. Cannon says, an anembryonic pregnancy is caused by a chromosomal abnormality. Unfortunately, though, there isn't always a clear explanation.
What we do know, however, is that they are very common. Dr. Cannon notes that a blighted ovum is the cause behind a staggering 50 percent of first-trimester miscarriages.
How is it treated?
An anembryonic pregnancy will be treated differently for every woman, depending on the pregnancy. In the case of an early pregnancy, a doctor might advise the woman to wait a week and then do a repeat ultrasound, just to make sure that no embryo has formed. In other cases, such as if a woman has already started bleeding but is stable, a doctor may offer to do a D&C (dilation and curettage, to clear the uterine lining of tissue) or give the woman the option of letting the miscarriage happen naturally. A woman might also take medication to help pass the products of conception at home.
"I carefully counsel patients on what to expect when there is no need to stay in the hospital," explains Dr. Cannon. "Many times it helps to be at home."
In very rare cases, a pregnancy may also develop outside the uterus or womb, either as an ectopic pregnancy in one of the Fallopian tubes or somewhere else in the body, such as on the ovaries or attached to the bowel. In these cases, the woman may need a special medication called methotrexate, which causes the tissue to stop growing and allows the body to expel the non-viable pregnancy. This medication must be administered in the hospital and may cause lower abdominal pain,fatigue, nausea, vomiting,and muscle soreness.
No matter which path of treatment you take, your doctor will most likely order you to have weekly blood tests until your hCG (Human chorionic gonadotropin, or "pregnancy hormone") levels fall into the range of a non-pregnant woman.
How is a blighted ovum miscarriage different than other types of loss?
A blighted ovum pregnancy can continue for days and even weeks before the body realizes that the pregnancy is not viable, which can make it that much harder for a woman experiencing it. My own blighted ovum miscarriage took more than two months to happen naturally, and going through that experience made me realize why some women would make the choice to have a D&C, to have closure faster. Every woman and pregnancy will be different, but talk to your doctor about what the best choice for you might be.
If you miscarry naturally at home, a blighted ovum means that you won't physically see an embryo or anything that resembles a baby. Some women may see a formed sac, but more likely, the miscarriage will only look like blood clots and thick tissue. This is important to recognize, because some women might struggle with never seeing physical "evidence" of the pregnancy, so they may need other physical signs of closure as they move through their grieving process.
Physical Healing After a Blighted Ovum
Physical healing after a miscarriage will also be different for every woman. My miscarriage involved more than two months of bleeding, while other women may bleed for only a few days. Healing will depend on if you miscarried naturally or had a D&C, and also how far along you were. You may feel extra fatigued and your hormones and emotions might feel like a roller coaster.
What to Expect After Miscarriage
In general, Dr. Cannon recommends that women healing after a miscarriage continue taking their prenatal vitamins and abstain from sex, douching, and tampons for at least a month after passing the tissue, no matter if the loss happened surgically, medically, or naturally. Women may expect the return of their menstrual cycle in about one month, and the initial cycle may be heavier than normal. Many doctors used to advise women to wait two to three menstrual cycles before trying to conceive again, but newer recommendations from The American College of Obstetricians and Gynecologists have found no evidence of any benefits to delaying conception. So a woman can try to conceive again as soon as she feels comfortable, although you may want to wait until after you've had a menstrual period so calculating the due date of your next pregnancy is easier.
Dr. Cannon also explains that if a blighted ovum occurs for a woman's first pregnancy or after she has had a healthy baby, it should not be cause for alarm. "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."
Emotional Healing After a Blighted Ovum
While the physical healing from a miscarriage may seem to happen fairly quickly, the emotional journey is a different story. I was actually surprised by how quickly my body seemed to want to go back to "normal" after my miscarriage. It felt like my body was all business as usual, even though my heart was not ready to move on. The emotional healing from a pregnancy loss can be a very difficult journey, and with a blighted ovum, it's especially important for a woman to realize that she has every right to acknowledge the full weight of her loss. I struggled with feeling like I did not have the "right" to grieve because I was never actually pregnant with a "baby."
But Dr. Cannon says it's important to recognize the loss. "I always stress to my patients that although there was no embryo, it was still a pregnancy," she explains. "Therefore, it is a miscarriage and she has every right to grieve. She really should grieve. The outcome is not what she expected."
She also notes that some women can experience postpartum depression after a pregnancy loss, so it's important to be aware of the symptoms and to talk openly and honestly with a partner who can monitor for any signs of postpartum depression as well.
To help heal after a loss, it may be helpful to try some of the following ways to honor your loss:
- Plant something in memory of the loss that will spring new life, such as a tree or flowering bush in your yard.
- Purchase a remembrance item, such as a pregnancy loss statue,necklace, or photo frame.
- Reach out to another mother who has experienced a loss—it can help to talk to someone who is feeling the same way you are. Or simply lean on a friend who will lend a genuinely sympathetic ear and offer encouragement.
- Try journaling to your baby to write out your feelings.
- Choose a special and/or inspirational song to listen to that is meaningful and/or uplifting to you.
No matter what way you choose to honor your loss, know that there is no one way to get through a miscarriage due to a blighted ovum. It's hard and it doesn't feel fair, but know that you are not alone. There are many women who know the pain you are feeling and it is important to acknowledge your loss and reach out for help when you need it the most.