I.

Introduction

Chances are you didnt even know you were pregnant or had just found out you were expecting when you received the shattering news that there is no visible developing embryo on the ultrasound. You are probably feeling sad and confused. As you take time to understand what this means, also take time to grieve as you would for any loss. And remember you are not alone. A blighted ovum (also known as anembryonic pregnancy) happens when a fertilized egg attaches itself to the uterine wall, but the embryo does not develop. Cells develop to form the pregnancy sac, but not the embryo itself. A blighted ovum usually occurs within the first trimester before a woman knows she is pregnant. A high level of chromosome abnormalities usually causes a womans body to naturally miscarry. A blighted ovum can occur very early in pregnancy, before most women even know that they are pregnant. You may experience signs of pregnancy such as a missed or late menstrual period and even a positive pregnancy test. It is possible that you may have minor abdominal cramps, minor vaginal spotting or bleeding. As with a normal period, your body may flush the uterine lining, but your period may be a little heavier than usual. Many women assume their pregnancies are on track because their hCG levels are increasing. The placenta can continue to grow and support itself without a baby for a short time, and pregnancy hormones can continue to rise, which would lead a woman to believe she is still pregnant. Though a blighted ovum can sometimes be the result of low hormone levels in the body, the major cause of the condition appears to be chromosomal. A blighted ovum is thought to occur when the chromosomes making up the fetus become defective or disordered, resulting in severe genetic defects. Your body recognizes these chromosomal abnormalities and chooses to end the pregnancy. A blighted ovum is the cause of about 50% of first trimester miscarriages and is usually the result of chromosomal problems. A womans body recognizes abnormal chromosomes in a fetus and naturally does not try to continue the pregnancy because the fetus will not develop into a normal, healthy baby. This can be caused by abnormal cell division, or poor quality sperm or egg A blighted ovum often causes no symptoms at all. Symptoms and signs may include: a missed or late menstrual period minor abdominal cramping minor vaginal spotting or bleeding a positive pregnancy test at the time of symptoms

II.

Objectives

General objectives: 1. Allow yourself to miscarry naturally. In many cases of blighted ova, the woman and the doctor decide to let nature take its course to pass the tissue of the pregnancy (placenta and sac) naturally. This process can take several weeks, however, and can be accompanied by cramping and heavy bleeding.

Specific objectives: 1. Use pain medications to help you cope with cramping. Any type of miscarriage, whether natural, with drugs or through surgery, is often accompanied by cramping. If the cramping is severe in nature, pain medications such as acetaminophen or ibuprofen can help.

2. Deal with your feelings. After a diagnosis of a blighted ovum, you may experience many emotions that can include anger, sadness, depression and frustration. You will also have to cope with the loss of the baby and pregnancy. Talking to a spouse, a good friend, a doctor or even a counselor can help you work through this disappointment.

III.

Nursing Health History

Mrs. C is a 35 year old female. Comes to a health facility for a fertility evaluation. Upon assessment she states that At 5 weeks I was told I had an empty sac in my uterus with no heartbeat. At 10 wks I was told by a nurse practitioner that she measured me at 5 weeks by internal examination and couldn't hear a heartbeat. Im currently 11 weeks pregnant, had 1miscarriage and a blighted ovum in the past. . Past Medical History History of: Negative for any major health problems. Pregnancy History History of: Prenatal visit. Gravida 4 Abortus 1. Three full-term pregnancies. Had a child with a birth weight over 9 pounds (4 Kg). Pregnancy, labor, or delivery

complications. Edema with past pregnancy. Miscarriage. Having a fetal death on her first pregnancy. She denied: Infertility.

IV.

Review of Systems

Respiratory She denied: Respiratory symptoms. Cardiovascular She reported: Weight gain She denied: Palpitations. Gastrointestinal She reported: Within the last six months change in eating habits. Abdominal crampimg, abdominal pain. Often eating as much as before She denied: Dysphagia. Nausea or vomiting. Diarrhea or constipation. Genitourinary She denied: Genitourinary symptoms. Hematological She denied: Increased bruising or prolonged bleeding. Musculoskeletal She reported slight feeling of tiredness and cramps most of the time. Neurological She denied: Headaches weekly. Neurological symptoms. Dizziness, lightheadedness, or syncope. Psychiatric She reported: stress, somatic symptoms, Under a great deal of stress. Worries a lot. Major life change recently. Another significant event within the last two years. She denied: Suicidal ideation. Depressed much of the time.. She reported: Never depressed.

V. Anatomy and Physiology

OVULATION

FERTILIZATION (spermatozoon w/ 23-chromosomes and ovum w/ 23chromosomes unite)

1st CELL DIVISION (Zygote 16-50 cells)

MORULA (because of its bumpy outward appearance)

BLASTOCYST (Lined the endometrial)

THROPOBLAST CELLS (cells forming the outer layer of blastocyst and develop in the larger part of placenta

EMBRYO (Implantation at endometrial, 8 to 10 days after fertilization)

GESTATIONAL SAC w/an EMBRYO

VI.

Pathology and Physiology

OVULATION

FERTILIZATION (spermatozoon w/ 22-chromosomes and ovum w/ 23chromosomes unite)

1st CELL DIVISION (Zygote 16-50 cells)

MORULA (because of its bumpy outward appearance)

BLASTOCYST (Lined the endometrial but not shows development of embryo)

THROPOBLAST CELLS (cells forming the outer layer of blastocyst and develop in the larger part of placenta

GESTATIONAL SAC without an EMBRYO

VII.

Laboratory Result

A blighted ovum cannot be diagnosed by measuring hCG levels. This is because the placenta that is present with a blighted ovum will continue to release hCG for a short period of time. This can often lead many women to mistakenly believe that they are still pregnant. The only sure way to diagnose a blighted ovum is through an ultrasound. An abdominal or transvaginal ultrasound will reveal whether or not a fetus is developing within your uterus. By the 8th to the 9th week, assuming the pregnancy is dated correctly, the baby/heartbeat should be able to be detected via ultrasound. The gestational sac can be visualized as early as four and a half weeks of gestation and the yolk sac at about five weeks. The embryo can be observed and measured as early as five and a half weeks, via transvaginal ultrasound with a full bladder. Ultrasound can also very importantly confirm the site of the pregnancy is within the cavity of the uterus.

VIII. Medical-Surgical Management Misoprostol (Cytotec) One common option is a drug called misoprostol, or Cytotec. Misoprostol is approved as a drug to prevent ulcers in patients taking NSAID pain relievers, but has been found to induce miscarriage. You will either take the pills orally, or insert them vaginally. You will start bleeding within one to two days after you take the misoprostol. The amount of bleeding and pain involved will be similar to that of a natural miscarriage. The benefits of using misoprostol are being able to be home when your miscarriage takes place, and being able to control when it happens. Side effects include vomiting, diarrhea, and abdominal pain. You doctor will check the levels of hCG in your blood weekly to make sure they go down. This will continue until the number is five or lower, which means no tissue remains. Dilation and Curettage Dilation and curettage, or D&C, is a surgical procedure to scrape the uterine lining, thus expelling the contents. For the D&C, you will be given a sedative or general anesthesia. Your cervix will be slowly dilated with metal cylinders of increasing width. Then, your uterine lining will either be suctioned out, or scraped with a thin blade. The contents may be sent to a lab for analysis. The main benefit of a D&C is closure. You get it over with, and there is no waiting. Complications are rare but include: hemorrhage, perforated uterus, and Asherman syndrome, a very rare complication which causes the uterus to fill with scar tissue. Some complications may affect your future fertility. Your doctor will monitor you blood hCG level until it is five or below.

Wait Another option is to simply wait for a natural miscarriage. You may be limited to two weeks or less of waiting, because infection or hemorrhage may occur. In this case, you will need a dilation and curettage. Benefits of waiting include avoiding complications associated with drugs and surgery, and being at home while you miscarriage happens. Complications are hemorrhage, and failure to expel all tissue. Your doctor will monitor you blood hCG level until it is five or below.

Drug Study: Stop taking Misoprostol and seek emergency medical attention if you experience an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives). Misoprostol may cause mild to moderate diarrhea, stomach cramps, and/or nausea. These problems usually occur during the first few weeks of treatment and stop after about a week. The occurrence of diarrhea may be minimized by taking Misoprostol with food. Contact your doctor if these symptoms persist for longer than 8 days or if they are severe. Other, less serious side effects may also occur. Continue to take Misoprostol and talk to your doctor if you experience

vomiting; flatulence; constipation; headache; or Menstrual cramps, spotting, or increased or irregular menstruation.

IX.

Discharged Planning

Nursing responsibility required informing that quite often; Mrs. Cs body will take care of the blighted ovum itself. She wills either naturally miscarry or her body will simply reabsorb the fertilized egg. If it is reabsorbed, she may have a heavier than usual period or clots in your period. The majority of health care providers agree that it is best to let a woman's body deal with the blighted ovum naturally. This also helps to ensure that there is no scarring, thereby allowing for optimal future fertility health. However, for some women it is simply too upsetting to just wait for a miscarriage. For women who have a medical problem, such as an infection or heavy bleeding, or who just

simply find it uncomfortable because they are having a lot of cramps, a surgical procedure may be done to remove the products of conception. Also dont forget that Genetic testing may also be advised to your husband to rule out genetic problems with him because of a probably second miscarriage.

Pamantasan ng Lungsod ng Maynila College of Nursing

Case Study on Blighted Ovum

Submitted to: Prof. Olivia Bacayao R.N.

Submitted by: Christian S. Tan BSN II-1