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“I went through two Blighted Ovum (BO) within a year, I’ve always blamed myself for not being able to prevent it from happening. As I started sharing my story, I realised that it is a fairly common condition which cannot be prevented.” ~ Rosemary, from “3 times pregnant in a year

Many are left with an unspoken heartache and guilt of a diagnosis that could not have been prevented. I Love Children invited Dr Janice Tung, consultant of Thomson Fertility Centre, to share more about this condition.

What is a Blighted ovum (BO)?

Dr Janice: It is also known as an anembryonic pregnancy, and as the name suggests, there is no embryo within the pregnancy sac. This can occur when the sperm fertilises the egg, but thereafter the early embryo either did not develop or stops developing very early and is reabsorbed into the body, leaving behind an empty pregnancy sac. An ultrasound scan of the pregnancy shows a pregnancy sac of a certain size, but no yolk sac or fetal pole is seen.

 

Are there any symptoms of BO? 

Dr Janice: Some women may experience symptoms of pregnancy as there is still a rise in pregnancy hormones. For others, there can be no symptoms, or symptoms of cramps and bleeding (whether light or heavy).

What are the possible causes of BO?

Dr Janice: The most likely cause of BO is a genetic abnormality with what should be the resultant early embryo after fertilisation. Certain genetic tests are possible with the pregnancy tissue from a D&C, but may be very limited in finding out the exact cause since not all genetic abnormalities can be tested for (hence a negative result does not exclude a genetic abnormality). 

The quality of the egg and/or sperm may have contributed to the BO since this occurs after fertilisation, however, exercise (including heavy lifting) and diet doesn’t cause BO.

 

“I sought comfort by reaching out to a friend who went through a BO, as well as a BO support group, to learn how others coped with the guilt, it wasn’t easy and it took a while, but the advice given by most ladies is to allow yourself to grieve and take comfort that you are not alone in this journey.” ~ Rosemary

 

How early can BO be detected? 

Dr Janice: It may be detected as early as 6 weeks from the last menstrual period (if the woman is certain of her dates), however, to err on the side of caution of a misdiagnosed in early gestation as an early developing pregnancy sac would also resemble a BO, most gynaes would reserve judgment until repeating the scan a week later to see if there's a further development in the pregnancy sac, no matter how certain the woman may be of her dates.

 

Is it possible for a BO to go undetected? 

Dr Janice: Some ladies who are not tracking their menstruation closely or have irregular menstrual patterns, may not realise they were ever pregnant or may just believe that their menstruation came and is slightly heavier. 

 

What are the treatments for BO?

Dr Janice: There are two ways to treat BO, they are through:

  • Expectant management: Waiting for the pregnancy to naturally be expelled at some point, however, the duration of waiting may be indefinite.
  • Medical management: Taking tablets to encourage the pregnancy to be expelled by inducing cramps and bleeding within 24 to 48 hours or surgery (D&C) to evacuate the womb. 

 

Is it possible to have multiple BO?

Dr Janice: Multiple BO are generally considered as repeat early miscarriages and most gynaes would suggest further evaluation for underlying issues such as an immunological disorder, clotting disorder, structural womb issues or genetic abnormalities, aside from basic screening tests for thyroid disease or diabetes. However, often, these tests return negative for any conditions, and there is no specific treatment recommended. Your gynae may discuss the suitability and risks of empirical treatment options that are of unknown benefit to you. A review of your weight and lifestyle habits could lead to recommendations to manage weight as well as avoiding smoking, excessive alcohol and caffeine consumption, in order to improve the outcome of a future pregnancy.

 

How soon after a BO can couples try to conceive again

Dr Janice: In general, it is thought that a couple may try to conceive again as soon as they feel ready, after confirmation of pregnancy resolution on the scan. This is usually about 2 weeks after the pregnancy is thought to be expelled, or a D&C.

The general advice is to not lose hope and try again.

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