New Blighted Ovum Guidelines! Chances Are You Are Being Diagnosed Too Soon!
Before You Agree to End Your Pregnancy, You Really Need to Know This!
I am often asked questions about the diagnosis of a blighted ovum because of my own misdiagnosed blighted ovum story.
Whether you are going through a blighted ovum scare of your own, or know somebody who is, I want to encourage you to save this page and share it! This may save a life!
The UK has implemented new guidelines that, as a result, will save many babies. The United States and most other countries are still woefully behind and using antiquated standards that cause many women to be misdiagnosed. Even if you are from the UK, not all doctors are up to date. I encourage you to take these new standards with you to your next doctor's appointment.
You are your own best advocate!
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?
A blighted ovum occurs when a fertilized egg implants in the uterus but doesn't develop into an embryo (WebMD).
Simply, it just means the baby doesn't develop past implantation or is so early that you wouldn't see evidence of it via ultrasound.
I hear from women who they've been diagnosed with a blighted ovum because the doctor only sees a yolk sac in the gestational sac. This is not a blighted ovum!
If there is a yolk sac, there is strong evidence there is a baby. In the Journal of Ultrasound in Medicine, the article "Sonographic Evaluation of the Yolk Sac"—a very technical piece on the growth of the yolk sac—states that a yolk sac first develops near the developing heart of the baby.
The takeaway from this: If you see a yolk sac, there was, at some point, a baby. Yes, the pregnancy could stop developing from this point and result in miscarriage, but this is not a true blighted ovum
Before you read this page, let me give you the takeaway message: Unless your gestational sac is 25mm, and you've waited one week past this mark, it may be too early to diagnose a blighted ovum.
What Is a Gestational Sac?
Keeping in mind that ultrasound measurements are not as reliable as our doctors would have us believe, they can be useful in helping us determine if there is still hope.
As I said before, the UK has some new guidelines. Let's take a look at them, shall we?
(To view these new guidelines for yourself, you can download the PDF from the National Institute for Health and Care Excellence's site. CG154 Ectopic pregnancy and miscarriage: NICE guideline)
For gestational sacs that are more than 25mm:
If the mean gestational sac diameter is 25mm or more, using a transvaginal ultrasound scan, and there is no visible fetal pole:
- seek a second opinion on the viability of the pregnancy,
- and perform a second scan a minimum of seven days after the first before making a diagnosis.
For gestational sacs that are less than 25mm:
If the mean gestational sac diameter is less than 25mm, using a transvaginal ultrasound scan, and there is no visible fetal pole:
- perform a second scan a minimum of seven days after the first before making a diagnosis.
- Further scans may be needed before a diagnosis can be made.
In a nutshell, a blighted ovum should not be diagnosed during the first appointment. If your doctor is diagnosing you at the first appointment, it may be time to find a new doctor. Whether the sac is bigger than or less than 25mm, unless there is an immediate need to end the pregnancy, an ultrasound should be scheduled at least seven days out—six days is too soon! If the gestational sac is growing, keep having ultrasounds a week apart until you reach 25mm. Then schedule one more scan a week later to verify.
How Reliable Are Ultrasound Measurements?
For years, I've talked with women who had two ultrasounds by two different techs the same day, and the measurements were very different. I've blogged about a woman who shared with me that two different techs measured the exact same ultrasound picture and got two different measurements.
When you boil it down, ultrasound measurements are not accurate enough to be used to diagnose a blighted ovum.
Is Your Doctor Scaring You Into Ending Your Pregnancy?
In that same NICE report cited above, it recommends doctors inform women of what to expect while waiting for a repeat scan, and waiting for a repeat scan has no detrimental effects on the outcome of the pregnancy.
I cannot even begin to count the number of women who have contacted me and told me that their doctors have told them they are risking future fertility, or even their lives if they do not have an immediate dilation and curettage (D&C) for their blighted ovum. My own doctor told me at both seven and eight weeks what a risk I was taking by turning down the D&C. And, like me, a number of these women went on to have a viable pregnancy.
The takeaway from this: If the gestational sac is seen, and there are no additional symptoms (high fever, foul discharge, etc.), waiting it out is not only acceptable, it is now advisable.
Why is this page so important? Because now you have something from doctors, by doctors, to show your doctor at your next appointment. You have 'proof' (besides the hundreds, if not thousands of stories online) to show you are being diagnosed too soon!
How Important Is the Date of Your Last Period?
It's not that important. Many doctors are all about the dates of your last period and, as a result, are more likely to misdiagnose you.
Taken from the website of the Office of Women's Health, U.S. Department of Health and Human Services:
"Cycles can range anywhere from 21 to 35 days in adults and from 21 to 45 days in young teens."
Your doctor knows this. So, why are they still insisting on dating your pregnancy based on the average cycle?
According to that same NICE report cited above, "Do not use gestational age from the last menstrual period alone to determine whether a fetal heartbeat should be visible. Inform women that the date of their last menstrual period may not give an accurate representation of gestational age because of variability in the menstrual cycle."
Last menstrual period? Not so important. Sure, it gives a good general guideline, but unless you are almost in the second trimester, it's not a good indication of a blighted ovum.
The takeaway from this: If your doctor is basing your blighted ovum diagnosis on the fact that you are seven or eight weeks past your last period, and the baby isn't seen on an ultrasound, the doctor is wrong. It's still too early.
Are Your hCG Levels Important?
Again, hCG levels aren't that important. Generally, hCG levels seem most useful in helping to determine whether a pregnancy is ectopic or not. Once the gestational sac is seen, most doctors stop taking hCG levels because they can go up and be normal, or slow and plateau and still be normal. I've even talked to women whose numbers have declined, and they've had a normal viable pregnancy.
The takeaway from this: If your gestational sac has already been found, hCG levels won't really do much to help a diagnosis. With a blighted ovum, numbers can sometimes rise normally, and in a viable pregnancy, they may slow considerably. Your doctor needs to stop focusing on your levels.
Things to Remember About Diagnosing a Blighted Ovum
- Make sure the pregnancy is not ectopic, and stay closely monitored if the gestational sac is seen, and an ectopic pregnancy is a concern.
- Keep those ultrasounds spaced out by at least seven days. This gives everything enough time to grow and be seen on an ultrasound if the pregnancy is viable.
- Monitor your hCG levels, but remember that they are really only useful in determining if you're pregnant and whether or not it is an ectopic pregnancy. Once the gestational sac is viewed, hCG levels can do many different things in both blighted ovum pregnancies and normal, viable pregnancies. Don't get caught up in your hCG levels.
- Wait out a blighted ovum diagnosis if there are no complications. It is perfectly acceptable and even preferable.
- Find a doctor who won't try to scare you into ending your pregnancy too early.
- Get a second opinion if your doctor is diagnosing you too soon. Women do it all the time, and sometimes that is the way they end up finding awesome doctors.
In a nutshell, the size of the gestational sac is probably the most important key to diagnosing a blighted ovum.
The UK's Misdiagnosed Miscarriage Scandal
In 2011, the issue of misdiagnosed miscarriages came to light (in a big way) in the UK. As a result of the scandal, the UK revised their guidelines. Misdiagnosed miscarriages are very real. Our goal now is to get all doctors to realize the standards have changed, and save these babies' lives.
For years, we have been collecting stories of women who have had misdiagnosed miscarriages. In fact, on average, I hear from at least one woman a week who has gone through a misdiagnosed miscarriage. Rare occurrence? Absolutely not. And, if I hear from around one woman a week who has been misdiagnosed, how many more are there out there?
If there is a yolk sac or a fetal pole, this is not a blighted ovum. This does not mean the pregnancy is necessarily viable, though. Miscarriages can occur after these things are seen. It just means it is not a blighted ovum (and your doctor should know that).
What the New Guidelines Will Not Do
Sadly, miscarriages are very common. These guidelines will not prevent a miscarriage from happening. What these guidelines will do, however, is prevent a viable pregnancy from being ended too early.
Have You Been Diagnosed With a Blighted Ovum (Empty Gestational Sac)?
Are you going through a miscarriage scare? Do you think you are being diagnosed too soon? I'd love to hear from you. Comment below, or message me through my profile.
Tan, S. , Pektaş, M. K. and Arslan, H. (2012), Sonographic Evaluation of the Yolk Sac. Journal of Ultrasound in Medicine, 31: 87-95. doi:10.7863/jum.2012.31.1.87