What causes an anembryonic pregnancy?

 

Anembryonic pregnancy

Anembryonic pregnancy: how to detect it, what are the causes?

Anembryonic pregnancy is a phenomenon that is often overlooked. However, 25% of women are affected. If you are pregnant, how can you recognize a non-evolving pregnancy? What are the causes? What treatments are possible? 

What is a anembryonic pregnancy?

Anembryonic pregnancy is a phenomenon that affects one in four women at least once in their life . It is commonly referred to as spontaneous miscarriage or miscarriage, fetal death in utero or perinatal death , depending on the term at which the death of the fetus or newborn occurs. Here is what you need to know:

• Anembryonic pregnancy results in an arrest in the development of the embryo or fetus.
• Anembryonic pregnancy usually occurs when there is an abnormality during fertilization.
• When the spontaneous termination of pregnancy occurs before 20 weeks of pregnancy, it is called a spontaneous miscarriage.
• 85% of miscarriages occur during the first trimester
• According to the WHO, beyond 20 weeks of pregnancy, we speak of fetal death in utero
• Some non-developing pregnancies have no symptoms.

What are the causes of a anembryonic pregnancy?

Anembryonic pregnancy can be due to various abnormalities in the development of the embryo, rather than a consequence of pregnancy pathologies .

The clear egg

Also called a "white egg" or a blighted pregnancy , a blighted ovum refers to the cessation of development before the embryo even appears. If you are wondering why the embryo is not developing , it is due to an abnormality during fertilization .

The woman therefore has an ovular sac devoid of embryo . However, in the case of this non-evolving pregnancy, the Beta-HCG rate increases , as for an evolving pregnancy.

Embryonic death or death in utero

Another cause of a non-evolving pregnancy is embryonic death. The embryo's heart stops beating . This is called intrauterine fetal death when this occurs after 20 weeks of pregnancy.

This can happen for several reasons:

• An abnormality of the placenta such as infection, abruption or bleeding
• An abnormality in the baby such as a chromosomal abnormality, infection, malformation, heart disorder, overdue birth
• A maternal abnormality such as diabetes, thyroid problem, toxic consumption, hypertension, coagulation disorder

Molar pregnancy

Molar pregnancy is an abnormality of placental development , called gestational trophoblastic disease . It is characterized by:

• Degeneration of the placenta in the form of cysts
• An abnormal multiplication of the cells that limit the egg (the trophoblast)
• There may or may not be an embryo inside

Ectopic pregnancy

Also called an ectopic pregnancy , this pregnancy develops outside the uterine cavity . The egg implants in the fallopian tubes in 96 to 98% of cases , or on an ovary or the cervix. Places that are not suitable for the growth of the fetus.

The egg then eventually ruptures. Ectopic pregnancy can cause massive hemorrhage and there is then a risk for the pregnant woman . Management in the event of an ectopic pregnancy is an emergency.

What are the symptoms of a non-evolving pregnancy?

The warning signs

During a non-evolving pregnancy, certain signs can alert you:

• Vaginal bleeding
• Severe nausea and vomiting
• High blood pressure
• Severe abdominal pain

However, since some of these symptoms are similar to those of an ongoing pregnancy, it is quite difficult to detect an ongoing pregnancy on your own.

Asymptomatic non-evolving pregnancy

In the case of a blighted ovum, you experience pregnancy symptoms related to the Beta-HCG hormone , such as mood swings in the first month , or nausea. It is therefore difficult to realize it.

In some women, a anembryonic pregnancy does not cause any symptoms. Only control examinations, such as a dating ultrasound or a first trimester ultrasound can detect it .

When can we say that a pregnancy is not progressing?

Medical diagnosis

To detect a anembryonic pregnancy, an imaging examination is necessary. The professional in charge of your follow-up performs, depending on your morphology, an external or endovaginal fetal ultrasound to check the proper development of the fetus .

This examination can be carried out from the 4th week of pregnancy , or 6 weeks of amenorrhea. After the result, in case of doubt, the examination can be repeated every 7 days to check the progress of the pregnancy.

Anembryonic pregnancy and diagnostic error

The criteria for a diagnosis were established with the aim of avoiding diagnostic errors . During the ultrasound scan, the health professional examines:

• The size of the gestational sac with a threshold of 25 millimeters
• The cranio-caudal length or CCL (distance between the embryo's skull and its buttocks) with a threshold of 7 millimeters

If no cardiac activity is detected in the embryo , the anembryonic pregnancy is confirmed.

Anembryonic pregnancy: treatments

A non-evolving pregnancy can end on its own, without any medical intervention, with the expulsion of the fetus manifested by gynecological bleeding.

When the expulsion of the gestational sac is not complete , medical intervention is necessary to avoid complications. This can be done either by drug treatment or by surgical treatment.

Drug treatment

In the case of an early non-evolving pregnancy without complete expulsion , depending on the size of the gestational sac, the professional responsible for monitoring you will suggest a medical termination of pregnancy (MTP) .

He will prescribe you a drug treatment with misoprostol . This treatment can be done up to 7 weeks of pregnancy in France (i.e. 9 weeks of amenorrhea).

This molecule is the synthetic version of prostaglandin E1 . It will enable uterine contractions.

Sometimes, another medication, mifepristone (Myfégine®), is administered 1 or 2 days before misoprostol, orally, it will allow the cervix to open .

In some cases, your doctor or midwife may recommend waiting for a natural miscarriage rather than offering these medications.

Surgical treatment

From 7 weeks of pregnancy , or 9 weeks of amenorrhea, surgery is necessary. This procedure can be performed up to approximately 22 weeks. For this, a one-day hospitalization is necessary.

After administering misoprostol , a general anesthetic is administered. Then the surgeon will perform a suction curettage, then evacuation of the uterine contents after dilation of the cervix.

When you wake up, it is recommended that you take a few days of rest to recover from the procedure.

When the pregnancy is more than 22 to 24 weeks of amenorrhea, feticidal anesthesia is recommended before the induction of labor , given the knowledge about pain in the fetus.

Protocols vary greatly from one team to another. Most often, it involves injecting an anesthetic or analgesic drug into the umbilical cord, followed by a feticidal drug (causing the death of the fetus).

What to do after a anembryonic pregnancy?

Pregnancy loss can cause a certain amount of anxiety . Even more so if the loss occurs at an advanced stage of pregnancy. We speak of perinatal bereavement from 22 weeks of amenorrhea, as the WHO points out.

Some women may develop a depressive syndrome . Following a spontaneous termination of pregnancy , it is important to have emotional support from your loved ones and/or a psychologist.

A healthcare professional can help you get through this ordeal better. Specialized support organizations can also help you.

FAQ

Is it risky to get pregnant after a anembryonic pregnancy?

If you have had 3 repeated miscarriages , we recommend that you consult a health professional to look for a cause for these miscarriages:

Anatomical cause (fibroids, polyps, endometriosis, etc.)

Genetic cause (chromosomal abnormality)

Hormonal cause (thyroid problem, diabetes, obesity)

Immune cause (coagulation disease or autoimmunity)

When does a miscarriage most often happen?

Miscarriage occurs in the majority of cases during the first trimester of pregnancy . From the third month of pregnancy (12 weeks of amenorrhea) the risk decreases drastically.