So You've Been Told You Have A Blighted Ovum
When You've Been Told You Have a Blighted Ovum
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 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 have no doubt before having her pregnancy ended.
I am not a medical professional. The information I share is meant to supplement the information given you by your doctor. If you feel your doctor is not doing enough for you or not willing to listen to your concerns, I strongly encourage you to take what you've learned here and 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.
Important Note: 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 this will not end in miscarriage. It just means you do not have a blighted ovum.
If you would like to learn more about blighted ova, you may find my Frequently Asked Questions about Blighted Ova page useful.
Since many of the questions have been covered on that last page, I'd like to move on to how a blighted ovum is diagnosed.
How A Blighted Ovum Is Diagnosed
unfortunately, many doctors make the diagnosis too early
Important Note: Please read through this entire section because we now know, the criteria given to doctors on diagnosing a blighted ovum is not always correct and mistakes are all too frequently made.
In a nutshell, a physician will often diagnose a blighted ovum when nothing is seen in the gestational sac. We've had some women tell us they've been diagnosed as early as five weeks.
According to the Encyclopedia of Medical Imaging, the criteria for a diagnosis of blighted ovum are:
1) failure to identify an embryo in a gestational sac measuring at least 20 mm via transabdominal ultrasound.
2) Failure to identify an embryo in a gestational sac measuring approximately 18mm or more via transvaginal ultrasound.
3) Failure to identify a yolk sac in a gestational sac measuring 13mm or more.
This is the criteria many doctors use when making the diagnosis of blighted ovum. Fortunately, due to the many Misdiagnosed Miscarriage Stories we are collecting on the Misdiagnosed Miscarriage site, we know that there is still a lot of hope even when these "benchmarks" are not met.
How To Know This Is Truly A Blighted Ovum - only time will tell.
Unfortunately, the only true test of 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 find their babies after eight weeks and, often, with gestational sacs measuring bigger than the 20mm given in ultrasound literature.
Edited to add, and this is important, new UK guidelines state that a pregnancy with a growing gestational sac should not be diagnosed until the sac has reached 25mm and then a follow-up ultrasound is done one week later to verify.
Important Note 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.
First things first, if you are being diagnosed with a blighted ovum before nine weeks, it really is too early to know with certainty this is indeed a blighted ovum. If you have a tilted uterus, and you need to ask because most women do not know until they ask, you really should wait to verify the diagnosis.
After nine weeks, some women have reported finding their babies. Although most women see their babies by nine weeks, some women have been even further along. We don't know the explanation behind why it takes so long to view babies sometimes but it does every great once in a while.
Also, do not be worried if you are told you look one to two weeks behind. Many women with a tilted uterus will 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. We've seen time and again, that once these women hit the second trimester and their uterus is no longer retroverted, their dates look right on again.
So, how do you know when to end the pregnancy? If you would rather have a D&C or medical miscarriage 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.
Keeping in mind that hCG levels start to really slow, plateau and even decline after seven or eight weeks, hCG monitoring is not really a good way to determine this is a blighted ovum. However, that said, if you are monitoring them and they are dropping a lot, then you know your body is probably preparing for miscarriage.
Bleeding is also not a very reliable sign of a blighted ovum. Up to 1 in 3 women will spot or bleed during their pregnancies.
If you get to ten weeks or so and are certain of your conception date and there is still no baby found on the ultrasound (done by a trained technician), you can be reasonable certain this is a blighted ovum. Some women have found their babies later and while they are the exception rather than the rule, this may be something you want to consider.
What it boils down to is that you do not need to 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 or more weeks. The waiting really is a miserable time but, unfortunately, it is the only way to know what is really 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 Can I Do After Being Diagnosed?
If you still have hope this might be a viable pregnancy, there are a few things you can do to be certain:
Ask to have your hCG levels monitored As stated before, hCG levels are not reliable after seven or so weeks because they do slow down a lot and even begin plateauing. However, if your levels are really low or if you see that your numbers are dropping a lot then you know that this may likely end in miscarriage. I've talked to women whose numbers began plateauing at 30,000 or so with no baby seen. They turned down their D&Cs and continued on with a viable pregnancy. That does happen.
Make certain your ultrasounds are done by fully-trained ultrasound technicians Studies have come out showing that physicians tend to make mistakes when it comes to ultrasounds because they only have cursory training with the equipment. Also, because they may not use the equipment properly, if you are pregnant, your baby may be at risk from improper use. You can ask to have your ultrasounds done only by fully-trained technicians.
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 (or until she knows for sure there is absolutely no hope) if she:
1) does not have a fever
2) has stable vital signs
3) has no excessive pain
4) has no excessive bleeding
Also, if you are ten weeks or less, many doctors encourage waiting for a natural miscarriage
Get a second opinion If you feel pressured to end your pregnancy before you are certain this is truly going to end in miscarriage and there are no complications, get a second opinion. Some women have told me they've even gotten third of fourth opinions before finding their babies! Really, I think a second opinion is only necessary if your doctor does not want you to wait this out and there are no complications. As I stated before, time is the only true test of a blighted ovum and 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 that baby until you are far enough along to have that baby seen. Having a physician, though, who will listen to your concerns and will not rush a D&C can be very helpful in getting through this time.
Find support. You are going to find that 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. Find friends to help you through this time. You may also choose to find support online. Many women join the Misdiagnosed Miscarriage site because there are always women there going through this scare and women who have already been through it and are willing to provide support. Sometimes women are not comfortable posting and instead e-mail me ( firstname.lastname@example.org ) and I feel honored to be able to provide some support. Really, though, just having somebody who will listen and be supportive is the best way to get through this.
Important New Guidelines for Diagnosing a Miscarriage
The UK is the first to acknowledge that misdiagnosed miscarriages are indeed a problem. The Royal College of Obstetricians and Gynaecologists has revised its guidelines. If your gestational sac is more than 25mm and/or the CRL is 7mm 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. For more information (and something to take to your doctor), please, see my new page:
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