By Dr. Sara Fueyo Pestaña (Gynaecologist – Reg. No. 202008718).
An anembryonic pregnancy or blighted ovum is a type of pregnancy in which the gestational sac develops in the uterus, but there is no embryo inside.
It occurs very early in pregnancy, at the beginning of the first trimester, and occurs when the fertilised egg implants in the uterus but the embryo does not develop or stops developing soon after.
On ultrasound, an anembryonic or anembryonic pregnancy usually shows as an empty gestational sac with no evidence of an embryo. This can usually be diagnosed between 7 and 9 weeks gestation, when the embryo would be expected to be clearly visible on a transvaginal ultrasound.
Anembryonic pregnancy or blighted ovum is usually caused by chromosomal abnormalities in the fertilised egg, which prevent the embryo from developing properly from the start. These chromosomal abnormalities usually occur randomly during fertilisation, when the egg or sperm has an error in the number or structure of chromosomes.
It may be due to errors in cell division, defective eggs or sperm or, as in most cases, to advanced maternal age, as older women have a slightly higher risk of chromosomal problems in eggs.
More than symptoms per se, since it occurs at a very early stage of pregnancy, there are several signs that may raise suspicion of this condition, although they are not always conclusive.
An anembryonic pregnancy occurs when the gestational sac is formed inside the uterus, but due to genetic or chromosomal abnormalities the embryo does not develop. Generally around 6-7 weeks of gestation and by means of a diagnostic test such as an ultrasound scan, an empty sac can be observed in the uterus. The initial symptoms are similar to those of a normal pregnancy, although they gradually disappear as hormone levels decrease.
Ectopic pregnancy, on the other hand, occurs when the fertilised egg implants outside the uterus, usually in the fallopian tubes. This can cause symptoms such as severe abdominal pain and vaginal bleeding. An ultrasound scan will show that the gestational sac is not present in the uterus.
Chromosomal abnormalities in embryos can be detected through Preimplantation Genetic Diagnosis (PGD), a technique that allows for the genetic analysis of embryos before they are implanted into the uterus. Its goal is to identify embryos without chromosomal abnormalities, thereby reducing the risk of an anembryonic pregnancy and other genetic issues.
PGD helps identify embryos with a normal chromosomal makeup, which lowers the risk of developing an empty gestational sac. This technique is especially recommended for couples who have experienced recurrent miscarriages or implantation failures. It is particularly beneficial for women over 38 years old, who have a higher risk of chromosomal abnormalities in their eggs and can use this method to reduce the likelihood of an anembryonic pregnancy.
An anembryonic pregnancy is diagnosed through an ultrasound between weeks 7 and 9 of gestation. During this scan, the gestational sac may appear as an empty gestational sac, meaning no embryo is visible inside. In these cases, the doctor can confirm an anembryonic pregnancy.
Once the diagnosis of an anembryonic pregnancy is confirmed, it is necessary to proceed with the expulsion of the gestational sac. Treatment may include miscarriage, medication, or curettage to evacuate the uterine contents.
Normally, medications such as misoprostol are used, which stimulate uterine contractions and facilitate the expulsion of the gestational sac. This method is the most common because it avoids surgical procedures and is relatively safe and effective for most patients.
In some cases, a curettage or manual aspiration may be performed, although it is a much more invasive method. It is also possible to wait for the body to expel it naturally. This option can take several weeks, and during this time, the patient may experience bleeding and cramping as the body expels the sac. This method is suitable for patients who prefer to avoid medical interventions and have stable health, although some patients prefer to use medications or undergo surgical intervention to avoid this waiting period.
Doubilet PM., Benson CB., Bourne T., Blaivas M.
Diagnostic criteria for nonviable pregnancy early in the first trimester.
New England Journal of Medicine.
2013;
1443-1451
Diagnostic criteria for non-viable pregnancy in the first trimester:
https://doi.org/10.1056/NEJMra1302417
Abdallah Y., Daemen A., Kirk E.
Limitations of current definitions of miscarriage using mean gestational sac diameter and crown-rump length measurements: a multicenter observational study.
Ultrasound in Obstetrics & Gynecology.
2011;
497-502
Study on ultrasound criteria and definition of spontaneous abortion:
https://doi.org/10.1002/uog.10109
National Institute for Health and Care Excellence.
Ectopic pregnancy and miscarriage: diagnosis and initial management. NICE guideline NG126.
National Institute for Health and Care Excellence (NICE).
2019;
Guide on the diagnosis and initial management of ectopic pregnancy and spontaneous abortion:
https://www.nice.org.uk/guidance/ng126?utm_source=chatgpt.com
Kolte AM., Bernardi LA., Christiansen OB., Quenby S., Farquharson RG., Goddijn M.
Terminology for pregnancy loss prior to viability: a consensus statement from the ESHRE early pregnancy special interest group.
Human Reproduction.
2015;
495-498
Consensus on terminology for early pregnancy loss:
https://doi.org/10.1093/humrep/deu299
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