So You've Been Told You Have a Blighted Ovum
I am often asked questions about the diagnosis of a blighted ovum because of my own misdiagnosed blighted ovum story.
Six years ago, when facing my own diagnosis, there was virtually no information on misdiagnosed miscarriages online. In fact, women on miscarriage sites told me, kindly, to just have the D&C and move on.
Thankfully, I did not listen, and my daughter is here today.
You may or may not have that happy ending. Unfortunately, time is the only true test of a blighted ovum. I'd like to share some of what I've learned so far, so that you can make an informed decision on how and when to end your pregnancy, or whether it needs to be ended at all.
I believe every woman deserves to not have any doubts before ending her pregnancy.
I am not a medical professional. The information I share here is not meant to replace the information given to you by your doctor. If you feel your doctor is not doing enough for you or is not willing to listen to your concerns, I strongly encourage you to get a second opinion.
What Is a Blighted Ovum?
Let's start with the basics. A blighted ovum is an egg that is fertilized but does not develop after implantation. Your doctor may also refer to this as an anembryonic or empty sac pregnancy.
Let's move on to how a blighted ovum is diagnosed.
If you are able to see a yolk sac during the ultrasound, you do not have a blighted ovum. A baby is needed for the yolk sac to appear. That does not mean the pregnancy will not end in miscarriage, it just means you do not have a blighted ovum.
How a Blighted Ovum Is Diagnosed
Note: Please read through this entire section because the criteria given to doctors for diagnosing a blighted ovum is not always correct, and mistakes are frequently made.
Unfortunately, many doctors make the diagnosis too early. In a nutshell, a physician will often diagnose a blighted ovum when the gestational sac is empty. Some women have said they were diagnosed as early as five weeks.
According to the Encyclopedia of Medical Imaging, the criteria for a diagnosis of a blighted ovum are:
- Failure to identify an embryo in a gestational sac measuring at least 20 mm via transabdominal ultrasound.
- Failure to identify an embryo in a gestational sac measuring approximately 18 mm or more via transvaginal ultrasound.
- Failure to identify a yolk sac in a gestational sac measuring 13 mm or more.
This is the criteria many doctors use when making the diagnosis of a blighted ovum. Fortunately, there is still hope even when these "benchmarks" are not met.
How Do You Know If This Is Truly a Blighted Ovum?
Unfortunately, the only true way to test for a blighted ovum is time. If you've been told a baby is always seen by seven or eight weeks, you've been misinformed. Many women with gestational sacs measuring bigger than the 20 mm find their babies after eight weeks.
The UK is the first to acknowledge that misdiagnosed miscarriages are indeed a problem. The Royal College of Obstetricians and Gynecologists have revised their guidelines. If your gestational sac is more than 25 mm and/or the CRL is 7 mm or more, you should wait a week to verify, if there are no complications. If the measurements are less, you are too early to diagnose.
The vast majority of women who find their babies after eight weeks have a tilted uterus. Although some women who have an anteverted uterus (normal position) have found their babies later as well.
Does a Tilted Uterus Matter?
First things first, if you are being diagnosed with a blighted ovum before nine weeks, it is too early to know with certainty that it is indeed a blighted ovum. If you do not know if you have a tilted uterus, you need to ask your doctor because that should be verified before making a diagnosis.
After nine weeks, some women have reported finding their babies. Although most women see their babies by nine weeks, some women have been further along. We don't know the explanation as to why it takes so long to view some babies, but it does happen.
Also, do not be worried if you are told you look one to two weeks behind. Many women with a tilted uterus look one to two weeks behind even if they are certain of their conception date. In fact, many women are misdiagnosed after IVF for this very reason. Once these women hit the second trimester, and their uterus is no longer retroverted, their dates line up.
How Do You Know When to End the Pregnancy?
If you would rather have a medical miscarriage, called a dilation and curettage (D&C), than a natural miscarriage, that is your right. Many doctors still encourage a natural miscarriage up to ten weeks. After ten weeks, even if you decide to have a natural miscarriage, you are more likely to need a D&C due to complications.
Low hCG Levels
Keep in mind that hCG levels start to slow down and plateau or even decline after seven or eight weeks of pregnancy. So hCG monitoring is not an accurate way to determine if this is a blighted ovum. However, if you are monitoring your hCG levels and they are significantly dropping, then you know your body is probably preparing for miscarriage.
Spotting or Bleeding
Bleeding is also not a very reliable sign of a blighted ovum. As many as one in three women will spot or bleed during their pregnancies.
Over Ten Weeks
If you get to ten weeks and are certain of your conception date, and there is still no baby found on the ultrasound (performed by a trained technician), you can be reasonably certain that you have a blighted ovum. Some women have found their babies later, and while they are the exception to the rule, this may be something you want to consider.
What it boils down to is that you shouldn't be pressured into a D&C too early. You can wait out a diagnosis. If you discuss the signs of infection with your physician and stay monitored, you can choose to wait. Some women only wait a week or so, and others end up waiting four weeks or more. The waiting is miserable, but it is the only way to know for sure what is happening.
Many women find their babies after eight or nine weeks. If you are being diagnosed before nine weeks, you have a greater risk of being misdiagnosed.
What Are Your Options After Being Diagnosed?
If you still have hope that this might be a viable pregnancy, there are a few things you can do.
- Ask to have your hCG levels monitored. As stated before, hCG levels are not reliable after about seven weeks because they slow down and begin to plateau. However, if your levels are really low, or if you see that your numbers are dropping significantly, then it may end in miscarriage. I've talked to women whose numbers began plateauing at around 30,000 with no baby seen. They turned down their D&C and continued on with a viable pregnancy. That does happen.
- Make certain your ultrasounds are done by fully-trained ultrasound technicians. Recent studies have shown that physicians tend to make mistakes when it comes to ultrasounds because they only have cursory training with the equipment and may not use it properly. If you are pregnant, your baby may be at risk from improper use. Don't be afraid to ask to have your ultrasounds done by a fully-trained technician.
- You can decline to have the D&C. According to the Journal of Family Practice and other medical organizations, a woman can safely wait to miscarry naturally if she:
- does not have a fever,
- has stable vital signs,
- has no excessive pain, and
- has no excessive bleeding.
Also, if you are ten weeks or less, many doctors encourage waiting for a natural miscarriage.
When Should I Get a Second Opinion?
If you feel pressured to end your pregnancy before you are certain it is going to end in miscarriage and there are no complications, get a second opinion. Some women have told me they've even gotten third or fourth opinions before finding their babies!
I think a second opinion is only necessary if your doctor does not want you to wait and there are no complications. As I stated before, time is the only true test for a blighted ovum. If a trained technician in the first office does not see your baby, chances are a trained technician in the second office will not see your baby either. They'll have to wait until you are far enough along.
It is crucial to have a physician who will listen to your concerns and not rush a D&C. Having a doctor who is compassionate and understanding is incredibly helpful when going through this stressful and uncertain time.
Find the Support You Need
This may be one of the loneliest and most miserable times you will go through. Honestly, the waiting is awful, and the only thing that helps is knowing you are not alone and that you have support.
Open up to close family and friends to help you through this time. There are also support groups and online forums that can be helpful. Many women join an online support group, like the Misdiagnosed Miscarriage forum, because finding a community of other women experiencing this, or who have experienced it in the past, is priceless and helps you feel less alone.
Have I left anything out? Can you think of anything I can add to make this article more useful? Do you just need somebody to listen? Please, leave a comment below. If you are someone who isn't comfortable posting in public forums, please feel free to reach out to me personally through my profile. I would be honored to help you. Really though, just having somebody who will listen and be supportive is the best way to get through this.
If you'd like to read more about my misdiagnosed miscarriage, check out When a Blighted Ovum Is Not a Blighted Ovum.
Chaudhry K, Siccardi Ma. Blighted Ovum (Anembryonic Pregnancy) [Updated 2018 May 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-.Available from: https://www.ncbi.nlm.nih.gov/books/NBK499938/