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Article Link: http://www.webmd.

com/baby/guide/blighted-ovum

Health & Pregnancy


Blighted Ovum
In this article

What Causes a Blighted Ovum?


Signs of a Blighted Ovum
Diagnosing a Blighted Ovum
What Happens After a Miscarriage?
A blighted ovum occurs when a fertilized egg implants in the uterus but doesn't
develop into an embryo. It is also referred to as an anembryonic (no
embryo) pregnancy and is a leading cause of early pregnancy failure or miscarriage.
Often it occurs so early that you don't even know you are pregnant.
A blighted ovum causes about one out of two miscarriages in the first trimester of
pregnancy. A miscarriage is when a pregnancy ends on its own within the first 20
weeks.
When a woman becomes pregnant, the fertilized egg attaches to the uterine wall. At
about five to six weeks of pregnancy, an embryo should be present. At about this
time, the gestational sac -- where the fetusdevelops -- is about 18 millimeters wide.
With a blighted ovum, though, the pregnancy sac forms and grows, but the embryo
does not develop. That's why a blighted ovum is also called an anembryonic
pregnancy.

What Causes a Blighted Ovum?


Miscarriages from a blighted ovum are often due to problems with chromosomes, the
structures that carry genes. This may be from a poor-quality sperm or egg. Or, it may
occur due to abnormal cell division. Regardless, your body stops the pregnancy
because it recognizes this abnormality.
It's important to understand that you have done nothing to cause this miscarriage
and you almost certainly could not have prevented it. For most women, a blighted
ovum occurs only once.

Signs of a Blighted Ovum


With a blighted ovum, you may have experienced signs of pregnancy. For example,
you may have had a positive pregnancy test or a missed period.

Then you may have signs of a miscarriage, such as:

Abdominal cramps
Vaginal spotting or bleeding
A period that is heavier than usual.
If you're experiencing any of these signs or symptoms, you may be having a
miscarriage. But not all bleeding in the first trimester ends in miscarriage. So be sure
to see your doctor right away if you have any of these signs.

Diagnosing a Blighted Ovum


If you thought you had a normal pregnancy, you're not alone; many women with a
blighted ovum think so because their levels of human chorionic gonadotropin (hCG)
may increase. The placenta produces this hormone after implantation. With a
blighted ovum, hCG can continue to rise because the placenta may grow for a brief
time, even when an embryo is not present.
For this reason, an ultrasound test is usually needed to diagnose a blighted ovum -to confirm that the pregnancy sac is empty.

What Happens After a Miscarriage?


If you have received a diagnosis of a blighted ovum, discuss with your doctor what to
do next. Some women have a dilation and curretage (D and C). This surgical
procedure involves dilating the cervix and removing the contents of the uterus.
Because a D and C immediately removes any remaining tissue, it may help you with
mental and physical closure. It may also be helpful if you want a pathologist to
examine tissues to confirm the reason for the miscarriage.
Using a medication such as misoprostol on an outpatient basis may be another
option. However, it may take several days for your body to expel all tissue. With this
medication, you may have more bleeding and side effects. With both options, you
may have pain or cramping that can be treated.
Other women prefer to forego medical management or surgery. They choose to let
their body pass the tissue by itself. This is mainly a personal decision, but discuss it
with your doctor.
After a miscarriage, your doctor may recommend that you wait at least one to three
menstrual cycles before trying to conceive again.

WebMD Medical Reference


Reviewed by Nivin Todd, MD on April 17, 2015
2015 WebMD, LLC. All rights reserved.

Article Link: http://www.webmd.com/infertility-and-reproduction/news/20030605/how-stress-causesmiscarriage

Infertility & Reproduction Health Center

How Stress Causes Miscarriage


Hormonal Effects on Certain Cells May Trigger Chain
Reaction to End Pregnancy
By Sid Kirchheimer
WebMD Health News
WebMD News Archive

June 5, 2003 -- Stress has long been suspected as a possible cause of miscarriage,
with several studies indicating an increased risk among women reporting high levels
of emotional or physical turmoil in their early months of pregnancy or just
before conception. But while a relationship has been noted, researchers didn't know
exactly how a woman's stress could cause miscarriage.
In what may prove to be a breakthrough finding, a team of scientists from Tufts
University and Greece have identified a suspected chain reaction detailing exactly
how stress hormones and other chemicals wreak havoc on the uterus and fetus.
Their report, in the June issue of Endocrinology, may help explain why women
miscarry for no obvious medical reasons and why some women have
repeated miscarriages. And it could lead to measures to prevent miscarriage -medically known as "spontaneous abortion."
Researchers have long known that during times of stress, the brain releases several
hormones -- including one called corticotropin-releasing hormone (CRH). In past
research, women who deliver prematurely or have low-birth-weight babies were
often found to have high levels of CRH in their bloodstream, and other studies show
a greater risk of miscarriage in women reporting stress. CRH is a hormone
the brain secretes in reaction to physical or emotional stress, and it is also produced
in the placenta and the uterus of a pregnant woman to trigger
uterine contractions during delivery.
But this new research suggests that CRH and other stress hormones may also be
released elsewhere in the body, where it specifically targets localized mast cells -those best known for causing allergic reactions. Mast cells are abundant in the
uterus. During stress, the local release of CRH causes these mast cells to secrete
substances that can cause miscarriages.

The Hormone-Allergy Link

In their study of 23 women, the scientists found that those who had previous multiple
miscarriages had significantly high levels of CRH and another hormone, urocortin, in
the tissues of their fetuses when compared with women who miscarried once or
those who had had abortions.
The lead researcher tells WebMD what's especially intriguing is that high amounts of
these stress hormones were found only in uterine mast cells -- and not in the
women's bloodstream, adding credence to his theory that CRH may be released
locally.

The Hormone-Allergy Link continued...


"Mast cells are like a soccer ball that is filled with about 500 Ping-Pong balls, and
each Ping-Pong ball has about 30 marbles," says Theoharis C. Theohardies, MD,
PhD, of the Tufts University School of Medicine. "If you are allergic, these cells
explode like a grenade to trigger an allergic reaction by releasing all those balls of
histamine and various other chemicals."
Like an allergen, CRH and urocortin in mast cells may also release many chemicals.
The chemicals known to cause fetal loss were also found in high amounts in the
women studied who had one or more miscarriages.
"Tryptase [the chemical released by the activated mast cell] acts like a meat
tenderizer, destroying tissue, and it prevents the production of membranes to
develop the embryo and disrupts the whole architecture of the placenta that feeds
the baby," Theohardies tells WebMD. "When this happens early in pregnancy, it
causes a miscarriage."
"I think this is very exciting," says Calvin J. Hobel, MD, of Cedars-Sinai Medical
Center in Los Angeles, whose study four years ago in the American Journal of
Obstetrics and Gynecology linked high CRH levels with a greater risk of premature
birth. "It brings the continuum together because most of us have been looking at
[CRH's effect on] the end of pregnancy or the middle of pregnancy."
Hobel tells WebMD that Theohardies' finding could play a key role in the future of
prenatal diagnosis, in which a piece of the placenta is removed and cells are
examined for genetic disorders. He is researching how CRH can be studied this way
to better ensure a full-term and healthy delivery.

And Theohardies says he is hopeful that with his new research, women at risk of
miscarriage may be able to take preventative measures, especially when under
stress during pregnancy. "We know how to block the action of CRH on mast cells, so
perhaps we could give women at risk a vaginal suppository with drugs that block
CRH receptors."
But more immediately, he says his finding offers more proof of the hazards of
emotional stress on pregnancy. "We now know the effects of stress (on the fetus) are
very real and produce a specific physiologic reaction in the uterus," he tells WebMD.
"So you really need to reduce it whatever way you can."

The Hormone-Allergy Link continued...


From Egg to Embryo: See the Conception Process
2003 WebMD, Inc. All rights reserved.

Anembryonic pregnancy
Dr Henry Knipe and A.Prof Frank Gaillard et al.

Anembryonic pregnancy is a form of a failed early pregnancy, where a gestational sac develops, but
the embryo does not form. The term blighted ovum is synonymous with this, but is falling out of
favour and is best avoided.

Clinical presentation
The patient may be asymptomatic, presenting for an early pregnancy ultrasound. Alternatively, she
may present with vaginal bleeding in early pregnancy. Due to falling hCG levels, the clinical signs of
pregnancy tend to subside.

Pathology
In anembryonic pregnancy, a blastocyst is formed from a fertilised ovum but the fetal
pole/embryo never develops, though histologically some fetal material can be demonstrated in most
cases.
Human chorionic gonadotropin (beta-hCG) is formed due to invasion of endometrium by the
syncytiotrophoblast, and as a result there is a positive pregnancy test and clinical signs of pregnancy
are present.

Radiographic features
Ultrasound

An anembryonic pregnancy may be diagnosed when there is no fetal pole identified on endovaginal
scanning 4, and:

the size of the gestational sac is such that a fetal pole should be seen: MSD 25 mm on TVS
(by RCOG criteria)

Or

there is little or no growth of the gestational sac between interval scans


o
o

normally the MSD should increase by 1 mm per day


if the MSD is too small to determine the status of the fetus on the initial ultrasound, a
follow up scan in 10-14 days should differentiate early pregnancy from a failed pregnancy
(see: pregnancy of uncertain viability)

Other ancillary features have been described, and may be considered poor prognostic factors, but do
not contribute to the formal diagnosis of a failed pregnancy. These include:

absent yolk sac when MSD >8 mm (on TVS)

poor decidual reaction: often <2 mm

irregular gestational sac shape

abnormally low sac position

Differential diagnosis
Conditions that cause an empty gestational sac include:

early pregnancy (intrauterine)

pseudogestational sac

gestational trophoblastic disease: especially 1st trimester molar pregnancies 5

References

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Ultrasound Clinics 2 (2007) 175-185
4. Dogra V, Paspulati RM, Bhatt S. First trimester bleeding evaluation. Ultrasound Q.
2005;21 (2): 69-85. Ultrasound Q (link) - Pubmed citation
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(abstract) - Pubmed citation
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