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New Blighted Ovum Guidelines! Chances Are You ARE Being Diagnosed Too Soon!

Updated on September 07, 2014
image courtesy of istockphoto/ValuaVitaly
image courtesy of istockphoto/ValuaVitaly

Before You Agree to End Your Pregnancy, You Really Need to Know This!

Hi. I'm Kay. As a result of my own misdiagnosed blighted ovum, I started the Misdiagnosed Miscarriage site.

I don't know if you are here because you are going through a blighted ovum scare or know somebody who is but I want to encourage you to save this page and share it! Yes, 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 causing 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.

You are your own best advocate!

Disclaimer

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.

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 your blighted ovum.

Why is this page so important? Because now you have something FROM doctors BY doctors to show YOUR doctor. You have 'proof' (besides the hundreds, if not thousands of stories online) to show you are being diagnosed too soon!

What Is a Blighted Ovum?

because that is pretty important in understanding the diagnosis

I hear from women that they've been diagnosed with a blighted ovum because they doctor only sees a yolk sac in the gestational sac. No! This is not a blighted ovum.

What a Blighted ovum is (taken from WebMD's page Blighted Ovum page):

A blighted ovum occurs when a fertilized egg implants in the uterus but doesn't develop into an embryo.

Simple enough, it just means the baby doesn't develop past implantation or so early that we wouldn't see evidence of it via ultrasound.

Let me say, a yolk sac? Strong evidence of a baby and here is why:

While this is a very technical page on the growth of the yolk sac, you can see from The Journal of Ultrasound in Medicine's page Sonographic Evaluation of the Yolk Sac in the "Structure of the Yolk Sac" section that a yolk sac first develops near the developing heart of the baby.

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 but this is not a true 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.

For a little history, check out a few of the news articles:

Babies may have died after miscarriage misdiagnoses

Flawed miscarriage diagnosis criteria may lead to abortion of healthy babies: study

HSE apologises for miscarriage misdiagnoses

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 who are not contacting me?

Misdiagnosed Miscarriages are very real. As a result of the scandal in the UK, they've revised their guidelines. Our goal now is to get all doctors to realize the standard has changed and to save these babies lives.

What The 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)?

See results

Let's First Talk about How UNRELIABLE Ultrasound Measurements Are

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 two different techs measured the exact same ultrasound picture and got two different measurement.

WebMD in their Does ultrasound sometimes misdiagnose miscarriage article has this to say on ultrasound accuracy. In a nutshell:

A study was done to look at the actual accuracy of ultrasound measurements between doctors. The study found that gestational sac measurements could vary by, roughly, + or - 4mm either direction. This raised great concern especially when so close to the cut-off measurement in diagnosing a miscarriage.

When you boil it down, ultrasound measurements are not accurate enough to be used to diagnose a blighted ovum.

Next, Let's Talk Gestational Sacs.

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 25.0 mm 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/or

- perform a second scan a minimum of 7 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 25.0 mm with a transvaginal

ultrasound scan and there is no visible fetal pole, perform a second scan a

minimum of 7 days after the first before making a diagnosis. Further scans

may be needed before a diagnosis can be made.

Summed up in a nutshell? A blighted ovum should not be diagnosed the first appointment. If your doctor is diagnosing you in the first appointment, 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? Too soon!). If the gestational sac is growing, keep having ultrasounds a week apart until you reach 25mm and THEN schedule one more a week out to verify.

Let's Talk about Your Last Period

it's not so important

Many doctors are all about the dates of your last period and, as a result, more likely to misdiagnose you.

Taken from the Office of Women's Health, U.S. Department of Health and Human Service:

Cycles can range anywhere from 21 to 35 days in adults and from 21 to 45 days in young teens.

Your doctor knows this and now you know this so why are they still insisting upon dating your pregnancy as if it is the average cycle?

According to that same NICE report (CG154 Ectopic pregnancy and miscarriage: NICE guideline) you looked at above (on page 17):

Do not use gestational age from the last menstrual period alone to determine

whether a fetal heartbeat should be visible.

and

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.

LMPs (last menstrual period)? Not so important. Sure, it gives a good general guideline but unless you are coming up on the second trimester, it's not a good indication of a blighted ovum?

Takeaway: If your doctor is basing your blighted ovum diagnosis on the fact that you are seven or eight weeks and the baby isn't seen, he's wrong. It's still too early.

So You Know Your hCG Levels

again, not so 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. They can slow and plateau and be normal. I've even talked to women whose numbers have declined and they've been normal.

For more on hCG levels, I put together a page here to talk about this topic:

The First Trimester and Non-Doubling hCG Levels

Takeaway: If your gestational sac has already been found, won't really do much. 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.

Is Your Doctor Scaring You Into Ending Your Pregnancy

for a blighted ovum?

In that same study (CG154 Ectopic pregnancy and miscarriage: NICE guideline), I loved reading this (page 17):

Inform women what to expect while waiting for a repeat scan and that 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 their doctors have told them they are risking future fertility or even their lives if they do not have an IMMEDIATE D&C for their blighted ovum. My own doctor told me at 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 find their babies.

Takeaway: If the gestational sac is seen and there are no additional risks happening (high fever, foul discharge, etc...), waiting it out is not only acceptable, it is now advisable.

What Have We Learned Here?

about diagnosing a blighte ovum

In a nutshell, the size of the gestational sac is probably the most important key to diagnosing a blighted ovum.

Remember:

- First things first, make sure the pregnancy is not ectopic and stay closely monitored into the gestational sac is seen if this is a concern.

- Keep those ultrasound spaced out by AT LEAST seven days (gives everything time enough to grow and be seen if the pregnancy is viable.

- Your hCG levels are really only useful in determining a) you're pregnant and b) whether this is ectopic or not. Once the gestational sac is viewed, hCG levels can do many different things in both blighted ova pregnancies and normal, viable pregnancies. Don't get caught up in your hCG levels.

- If there is a yolk sac or a fetal pole, this is not a blighted ovum. Doesn't mean the pregnancy is necessarily viable because miscarriage can occur after these things are seen. Just means it is not a blighted ovum (and your doctor should know that).

- For a blighted ovum diagnosis, it is perfectly acceptable to wait out a diagnosis and, now, with the new guidelines, it is preferable. If there are no complications, find a doctor who won't try to scare you into ending your pregnancy too early.-

- If your doctor is just diagnosing you too soon, get a second opinion. Women do it all the time and some times they end up finding awesome doctors that way.

In a nutshell, the size of the gestational sac is probably the most important key to diagnosing a blighted ovum.

Are you going through a miscarriage scare? Do you think you are being diagnosed too soon? I'd love to hear from you.

Would Love to Hear From You

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    • profile image

      Ramya Nagesh 5 weeks ago

      My last LMP was 9th dec..After 1week again i got bleeding for 20days..march 4th i got to know am pregnant..

      Then we did ultrasound it was just 8mm in diameter gestational sac...hcg level was 3300

      Again after 2days we did hcg test again and it was 4328

      After 6days it was just 4450..

      Doc suggested for an uktrasound..

      He also told end of my pregnancy..Is it so..

      Please suggest me..am worried..i already had 2miscariage..

      This time am waiting..

    • profile image

      Lisa 2 months ago

      Hi

      I had some bleeding and had a internal scan, the doctor done my dates from LMP making me 7 weeks + 5 days. I know when I conceived and I make it 6 weeks.

      They only see a empty sac at 17mm and said the pregnancy has not been sucessful? I've got to go back for a follow up scan next week.

      I've stopped bleeding at the moment, do you think there's still hope?

    • profile image

      Tina 5 months ago

      Im 6w 4d told that my sak is filled with 3/4 blood and 1/4 amniotic fluid. No yolk sak or pole. My hcg are low went 7, 237, 412, 260, 800. Ive had 2 u/s verified not ectopic. They want me to do a dnc or medication to end the pregnancy.

    • profile image

      Mahea 8 months ago

      A few days ago I went to the ER with mild cramping my LMP was may 31 2016. I thought I was 7 weeks pregnant. So the first doctor comes in and does a transvaginal u/s we both saw a gestational sac but nothing else. She pulled the wand out super fast and told me she cannot see so she's gonna call the u/s tech. When the u/s tech started to do the ultrasound I asked do u see anything in there? She said she wasn't able to discuss that with me. Ok so now 3 hours went by and the ER doctor comes in and says we are waiting for the OB team to come and talk to u. Waited another hour the ob team came in and was giving me a few options. 1) to wait and see what my body does. 2) they could give me some medicine to terminate the pregnancy. 3) do a DnC. I asked why they said because they didn't see a baby only gestational sac. I said ill wait. They scheduled me 2 days later my hcg level is 14986 and 2 days later it was the same. They did another U/S and gave me the same options. I choose to wait. So I have another appointment next week Thursday and ive been praying. I still feel pregnant!!! Ive been reading alot on this and it gives me lots of hope. Thank you for the info I have lots of hope now!!!!

    • profile image

      Ramya 8 months ago

      I had a COH cycle with IUI and I am now 7 weeks pg. we had a 2nd U/S yesterday no fetal pole only a yolk sac. I didn't see the size of the gestational sac but the Dr (RE)has asked me to stop all medications and wait for a miscarriage. In the first U/S (7days prior) the gestational sac was 18.3mm. I feel like her diagnoses is premature and stopping medication could be putting my baby at risk. I refused a D&C and also medication to induce miscarriage. Any suggestions would be greatly appreciated.

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