Blighted ovum - empty amniotic sac

Suppose you are six to eight weeks pregnant and you are visiting the midwife for the first time. You have a positive pregnancy test, you feel pregnant, you have not had any blood loss. You think that's fine. This is usually the case and the first ultrasound shows evidence of the early pregnancy. However, in an average of 1 in 2000 women, nothing is seen in the womb. The amniotic sac is empty. This is called a 'blighted ovum', also called wind egg. But what exactly is it? And what next?

What is a blighted ovum?

In a blighted ovum, a fertilized egg has implanted itself in the uterus, but the cell division subsequently failed or did not proceed properly. Due to the successful implantation, the body does start to prepare for the growth of a child. An amniotic sac and placenta are created but no embryo develops in them. A bligthed ovum is certainly not the same as a false pregnancy. After all, as a woman you are really pregnant. The hormone (hCG) remains active in the body as long as the amniotic sac is present. You therefore also have the same pregnancy symptoms as a pregnancy with an embryo development.

It is not known how often a blighted ovum actually occurs. Pregnancy usually ends with an empty amniotic sac at an early stage in a miscarriage. Sometimes, however, it happens that the miscarriage takes longer or does not come on its own at all. Then the empty amniotic sac is seen during the first ultrasound at the midwife.

If a blighted ovum is detected during the ultrasound, it depends on the number of weeks that the pregnancy lasts until then what is advised. In any case, there is always the possibility to come by again after a few days for an ultrasound to make sure that there really is no embryo in development. Sometimes the pregnancy is so early that a sign of life cannot be visible on the first ultrasound. In exceptional cases, an embryo is still seen on a repeat ultrasound. If the pregnancy has already progressed further (past six weeks), the chance of this is minimal.

If there is indeed definitely an empty amniotic sac, then the least drastic option for the body is to wait for a spontaneous miscarriage. Usually before the tenth week of pregnancy, a miscarriage still spontaneously sets in motion and the pregnancy is thus terminated. If the miscarriage does not start on its own within a reasonable time, a follow-up policy will be determined in consultation with the midwife.

A choice can be to induce a miscarriage with special medication. The advantage of this is that the amniotic sac still leaves the body naturally and that no intervention is required. The method can be painful and in some cases there is such blood loss that a visit to the hospital is necessary. The method is also not completely reliable. Sometimes the miscarriage does not start with medication or an incomplete miscarriage follows, after which tissue remains in the uterus. Even then, hospital treatment is necessary.

Another or next option is curettage. During a curettage the uterus is emptied under anesthesia. An advantage of this method is that it is done with anesthetic and the procedure itself is therefore painless. Of course, pain complaints can be experienced after the procedure. In addition, an operation is never completely without risks. A complication can be, for example, that scar tissue forms in the uterus, which can make a possible subsequent pregnancy more difficult. However, hospitals have a lot of experience in performing curettages and the risks are therefore limited.

After the miscarriage has completely come about or the curettage has been performed successfully, the pregnancy is terminated and the pregnancy hormones leave the body by themselves. This also removes the pregnancy symptoms. The blood loss may persist for some time and symptoms may also develop that are consistent with the process of depregnation.

Emotionally, a blighted ovum can have a major impact. Even though an embryo has not visibly developed, there has indeed been a pregnancy with the accompanying emotions. From looking forward to the arrival of a little one, to saying goodbye to a built-up vision of the future. The process of awaiting a miscarriage and possibly undergoing a medical procedure often also has a major effect. It can take weeks to sometimes months from the time of the ultrasound to the definitive pregnancy. And because the pregnancy has never really become tangible, it can be difficult to say goodbye to a child who may never have really been there. It can help to read along with the experiences of other women. There are several forums online where women share their own experiences.