What is anembryonic pregnancy and how does it affect your antenatal care?

Anembryonic pregnancy, also known as a blighted ovum, is a condition that occurs in early pregnancy when the fertilised egg attaches to the uterus but fails to develop into an embryo. Although the pregnancy sac continues to grow, the embryo never forms or stops developing early on. This condition is often identified during antenatal care when a routine ultrasound is performed, revealing an empty gestational sac. In this article, we will explore what anembryonic pregnancy is, its causes, how it is diagnosed, the symptoms, and the potential treatment options. Additionally, we will look at the emotional impact of this condition and the importance of antenatal care during pregnancy. What is anembryonic pregnancy? Anembryonic pregnancy is a type of early pregnancy loss where the fertilised egg implants in the uterus but does not develop properly into an embryo. It typically occurs in the first trimester and can be devastating for expectant parents who may have hoped for a healthy pregnancy. In such cases, an empty gestational sac is observed on an ultrasound, even though the sac itself may appear to grow for a period.

Causes of anembryonic pregnancy

While the exact cause of anembryonic pregnancy is not always known, there are several factors that can contribute to this condition:

1. Chromosomal abnormalities: The most common cause of anembryonic pregnancy is chromosomal abnormalities in the fertilised egg. When there is an issue with the chromosomes, the embryo is unable to develop normally. These abnormalities often occur due to random errors during the division of cells after fertilisation, and unfortunately, they are beyond the control of the parents.
2. Hormonal imbalances: Hormonal imbalances, particularly those involving the thyroid or progesterone, can impact a pregnancy’s viability. Adequate progesterone levels are essential for the embryo to implant and develop properly. A deficiency in this hormone can lead to an early pregnancy loss or anembryonic pregnancy.
3. Uterine abnormalities: Structural abnormalities within the uterus, such as fibroids or an abnormally shaped uterus, may contribute to the development of anembryonic pregnancy. These abnormalities can interfere with the implantation process or prevent the embryo from growing properly.
4. Age of the mother: Women who are older, especially over the age of 35, may have a higher risk of chromosomal abnormalities, which can contribute to anembryonic pregnancy. The quality and number of eggs decline with age, which may lead to an increased chance of fertilisation issues.
5. Lifestyle factors: Poor lifestyle choices, such as smoking, excessive alcohol consumption, or being overweight, can also increase the risk of miscarriage and anembryonic pregnancy. These factors may interfere with the normal development of the embryo.

Symptoms of anembryonic pregnancy

Anembryonic pregnancy often has no distinct symptoms. In many cases, the pregnancy may seem normal initially. However, some common symptoms and signs may include:

1. Absence of fetal heartbeat: A key symptom of anembryonic pregnancy is the absence of a fetal heartbeat during a routine ultrasound. If a heartbeat is not detected after a certain point in the pregnancy (typically around 6–7 weeks), it may indicate that the embryo has not developed.
2. Vaginal bleeding: Some women with anembryonic pregnancy may experience vaginal bleeding or spotting. However, bleeding alone is not always a sign of miscarriage, as light bleeding can sometimes occur in a healthy pregnancy as well.
3. Abdominal pain: Mild cramping or pain in the lower abdomen may occur in some women with anembryonic pregnancy, though it is typically less intense than the pain experienced with a complete miscarriage.
4. Loss of pregnancy symptoms: A sudden reduction or disappearance of pregnancy symptoms, such as nausea, breast tenderness, or fatigue, can also be an indicator of a problem with the pregnancy, including anembryonic pregnancy.

Diagnosis of anembryonic pregnancy

Anembryonic pregnancy is often diagnosed through routine antenatal appointments that include an ultrasound scan. An ultrasound is typically performed between 6 and 8 weeks of pregnancy to confirm the presence of the embryo and detect a fetal heartbeat. If the ultrasound reveals a gestational sac without an embryo, the doctor may diagnose anembryonic pregnancy. In some cases, blood tests may be conducted to monitor the levels of human chorionic gonadotropin (hCG), a hormone produced during pregnancy. The levels of hCG may not rise as expected in cases of anembryonic pregnancy, and this can further confirm the diagnosis.

Treatment for anembryonic pregnancy

If anembryonic pregnancy is diagnosed, the pregnancy will usually not continue. There are several treatment options available, depending on the individual situation and how far along the pregnancy is:

1. Expectant management: In some cases, the body may naturally expel the empty pregnancy sac on its own. This is called expectant management, and it may take weeks for the process to occur. During this time, women will be monitored with additional ultrasounds and blood tests to confirm that the pregnancy is no longer viable.
2. Medical management: If the pregnancy does not naturally resolve, a medication called misoprostol may be prescribed to help the body expel the pregnancy tissue. This medication can help start the process of miscarriage by causing the uterus to contract.
3. Surgical management: In some cases, surgery may be necessary to remove the pregnancy tissue. This can be done through a procedure called a dilation and curettage (D&C), in which the cervix is dilated and the pregnancy tissue is carefully removed from the uterus.

Emotional and psychological impact of anembryonic pregnancy

The emotional toll of experiencing an anembryonic pregnancy can be significant. It is a devastating loss that can leave expectant parents feeling grief, confusion, sadness, and even guilt. The absence of an embryo can feel different from other types of pregnancy loss, and many women may struggle with feelings of doubt about their own body’s ability to carry a pregnancy to term. It’s essential to seek antenatal support, whether through counselling, support groups, or talking to a partner, friend, or family member. Seeking professional help from a therapist can be especially beneficial in processing the emotional effects of the loss. Antenatal care during recovery After an anembryonic pregnancy, it is important for women to receive appropriate follow-up care. This may include monitoring the recovery of the uterus, checking for any complications, and providing emotional support. Regular antenatal appointments and scans may be suggested if you choose to try again for another pregnancy. Many women go on to have healthy pregnancies following a blighted ovum, but support is crucial for physical and emotional healing. Anembryonic pregnancy is a condition where a fertilised egg attaches to the uterus but fails to develop into an embryo. It is often diagnosed during routine antenatal scans and may require medical intervention to resolve. Although this type of pregnancy loss can be heartbreaking, it is essential to remember that it is often caused by factors beyond control, such as chromosomal abnormalities. Antenatal care, including proper monitoring, emotional support, and follow-up appointments, can help guide you through this challenging time.