BLIGHTED OVUM

             BLIGHTED OVUM
I have been spending so much time with pregnant women of late such that my body, soul and spirit is in pregnancy-mode, I'm actually awaiting my 'first delivery' 3 days from today.  2 close relatives and a best friend are pregnant so I have been bombarded with lots of pregnancy questions. One of the questions that has always come up is about a formed pregnancy with no baby (embryo). This might sound very impossible but it’s a frequent phenomenon. My patients look at me in disbelief when I tell them that they are indeed pregnant but with no baby forming. I have had to take them step by step on the ultrasound till they get it. In the hospital I work in, I see at least two cases weekly. For those who don’t believe the diagnosis, we always advice them to repeat the ultrasound after a week or so, or get a second opinion for the sake of psychological satisfaction.



WHAT IS A BLIGHTED OVUM?

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. The pregnancy appears normal on an ultrasound scan in its early stages, but as the pregnancy progresses a visible embryo never develops or develops and is reabsorbed. In a normal pregnancy, an embryo would be visible on an ultrasound by six weeks after the woman's last menstrual period.

WHAT ARE THE CAUSES?
The causes of 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.

 For most women, a blighted ovum occurs only once in their lifetime but I have seen a few women getting it twice or thrice. It becomes very depressing for some.

WHAT ARE THE SIGNS?
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.

HOW IS IT DIAGNOSED?
An ultrasound test is usually needed to diagnose a blighted ovum -- to confirm that the pregnancy sac is empty. For diagnosis, the sac must be of sufficient size that the absence of normal embryonic elements is established. In case the doctor is doubtful, he can recommend one extra week of observation followed by a repeat scan to be sure of the diagnosis once a sufficient size of sac is achieved.

HOW TO TREAT IT

If you have received a diagnosis of a blighted ovum, discuss with your doctor what to do next. Some women have a dilation and curettage (D and C). This surgical procedure involves dilating the cervix and removing the contents of the uterus by curetting. Because a D and C immediately removes any remaining tissue, it may help you with immediate 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 ('the white tablet') to stimulate the uterus to expel the contents may be another option but this must be strictly done as an inpatient in case bleeding complications arise. 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 it must be discussed with a doctor. I remember almost losing a patient who decided to wait for the body to expel but ended up getting life threatening bleeding and ended up being rushed to theatre for an emergency D&C and had to have urgent transfusion.

HAVE I EVER SEEN A NON-DEVELOPING EMBRYO??

I remember doing a D&C and of course after almost rupturing the amniotic sac on my face, the small embryo came out. It was so small, about 3 cm long, I put it aside to study it after the D&C but of course it had melted into a white matter by the time I was done. This fascinated me.

I hope this post was educative enough and I hope that Doctors also stop telling patients 'mimba imeharibika na lazima uoshwe' (pregnancy is spoilt) instead of explaining the exact nature of the condition that made them miscarry and telling them all the options available for them.

Have a fruitful week!!!