Anembryonic Pregnancy
I. Introduction/Background of the study (global, national, local)
II. Demographic Data
III. Health History
A. Chief Complaint
B. Diagnosis
C. Review of Systems
D. Physical Examination Findings
E. History of Present Illness
F. Family History
IV. Etiology and Risk Factors
V. Pathophysiology
VI. Laboratory Results and Analysis Special Chemistry
i. Hematology
ii. Serology
iii. Ultrasound Result
VII. Drug Studies/ Pharmacologic intervention w/ Analysis
VIII. Nursing Care Plan
IX. FDAR Chart
I. Introduction/Background of the study (global, national, local)
A blighted ovum, also known as an anembryonic pregnancy, occurs when a
fertilized egg implants and a gestational (embryonic) sac form and grows, but the embryo
fails to develop. A blighted ovum is the single leading cause of miscarriage. This activity
outlines the management of blighted ovum and highlights the role of the interprofessional
team in educating the patient on this condition. In most cases, this type of miscarriage is
the result of genetic or chromosomal abnormalities, that occur at the time of fertilization
and that prevent a normal development of the embryo.
In a study, there was a high rate of abnormalities detected in the karyotypes of
miscarriages regardless of ultrasound findings prior to D&C. The abnormality rate in
anembryonic gestations was 58%, which was not statistically different from the 68% rate
seen in pregnancies with embryonic poles. This high rate of detected abnormalities should
encourage the physician who desires the information to perform the cytogenetic testing on
POC.
In an international study, pregnancy loss is a common obstetric complication and
affects > 30% of conception. The majority of these losses occur in the 1st trimester,
including spontaneous abortion, anembryonic gestation and embryonic or fetal death. The
prevalence of early pregnancy failure was 2.8% in a study involving 17,810 women at 10–
13 weeks’ gestation, and anembryonic pregnancies accounted for 37.5% of the pregnancies
lost. Loss before the development of an embryo is more likely to be associated with genetic
abnormalities than those later in gestation, and imparts a considerable influence on
recurring risk in subsequent pregnancies
Anembryonic pregnancy is defined as a gestational sac (GS) containing no fetal
pole with a mean diameter ≥ 15 mm, or a GS < 15 mm not showing any growth in 7 days.
Dilatation and curettage has been the primary treatment option for early pregnancy loss in
many countries since it was first introduced into clinical practice in the 1930s.
Treatment:
What are the treatment options?
If blighted ovum is discovered during a prenatal appointment, your doctor will discuss
treatment options with you. These may possibly include:
Waiting for miscarriage symptoms to occur naturally and taking medication, such as
misoprostol (Cytotec), to bring on a miscarriage
Having a D and C (dilation and curettage) surgical procedure to remove the placental
tissues from the uterus. The length of your pregnancy, medical history, and emotional state
will all be taken into account. The patient and her doctor will decide on the treatment
option. The patient will want to discuss the side effects and the standard risks associated
with any type of medication or surgical procedure, including a D and C.
II. Demographic data (age, gender, marital status, religion, weight, height)
Name: Patient X
Address: Tayug, Pangasinan
Birthday: November 1, 1998
Age: 24
Gender: Female
Education: N/A
Marital Status: Single
Nationality: Filipino
Religion: Roman Catholic
Date & Time of Admission: December 02, 2022
III. Health History
A. Chief complaint
Anembryonic Pregnancy
B. Diagnosis
Admitting diagnosis: Anembryonic Pregnancy
C. Review of system
No data
D. Physical Examination Findings
No data
E. History Of Present Illness
The patient condition started >1 month prior to admission, the patient had x
episode of vaginal spotting 3 days prior to admission the patient had her pelvic
ultrasound and noted to have anembryonic pregnancy hence consult and advised
admission for D&C
F. Family history
No data on family History
IV. Etiology and Risk Factors
The exact etiology for anembryonic pregnancies is difficult to ascertain. The etiological
factors for anembryonic pregnancies are generally understood and studied in the broader
context of early pregnancy loss (EPL) which includes both embryonic and anembryonic
pregnancies. Etiologies include:
Morphological abnormalities of an embryo that prevents implantation or prevents long term
survival of the embryo after implantation. These morphological abnormalities are thought to
be related to chromosomal abnormalities
Other genetic and chromosomal abnormalities include translocations, inversions, single-
gene perturbations, and placental mosaicism. Consanguineous marriages resulting in
anembryonic pregnancies have also been noted, suggesting a role of single gene
determinants. There is a probable link between DNA damage in sperm and miscarriage
Obesity and advanced maternal age are well-established factors associated with early
pregnancy loss
Malformation of the uterus that includes didelphic, bicornuate, and septate uteri can impede
in or prevent the long-term implantation of an embryo.
Immunologic disorders in the mother such as NK Cell Dysfunction, autoantibodies,
hereditary, and acquired thrombophilia, among others) can lead to the maternal
immunological rejection of the implanting embryo in the uterus resulting in miscarriage.
Hormonal factors (such as low levels of progesterone) and endocrinological disorders
(thyroid autoimmunity and thyroid dysfunction) play a complex role in miscarriage.
Polycystic ovarian syndrome is also associated with infertility and pregnancy loss.
Atypical pneumonia usually is caused by the influenza virus or other unidentified
microorganisms.
The role of alcohol consumption and it's associated increased risk in miscarriage has been
well established
Risk factors
1. Chromosomal Abnormalities
2. Obesity
3. Polycystic Ovarian Syndrome
4. Previous Early Pregnancy loss
5. Smoking & Heavy Alcohol use, caffeine use (Too much)
6. Other Lifestyle Factor
V. PATHOPHYSIOLOGY
Pathophysiology of Anembryonic Pregnancy
Empty Embryo
(due to chromosomal impairments and abnormalities)
Early Developed or Undeveloped Embryo Stop Developing But Reabsorbed
Empty Gestational Sac
Anembryonic Pregnancy
VI. Laboratory Results and Analysis Special Chemistry
i Name: Salvador, Pebbie Gell Macana Change Slip No.: LAB00141319
Physician: Patague, Joyce E., M.D. Room No: 217
Ae: 24/F Case No.: 2200001689
Exam No.: LAB0156472 Performed: 12/02/22 03:11 PM
HEMATOLOGY
Result Reference Result Reference
Hemoglobin 112 135-180 g/dL Segmenters 76.1 40-70
Hematocrit 34 40-54% lymphocytes 18.6 20-45
WBC Count 12.02 adults: 5-10x10/L Monocytes 4.8 2-10
Infants: 10-25x10/L
RBC Count 5.22 4.5-6.5x10/L Eosinophils 0.4 1-6
Platelet Count 339 150-400x10/L Basophils 0.1 less than 0.1
Blood type “B” 0-20
RH type positive Clotting Time 1-4
Performed: 12/02/22 03:11 PM
ii
i
SEROLOGY
Parameters Result
HBsAg (Immunochromatography) Nonreactive
Anti-HCN (Immunochromatography) Nonreactive
iii
Diagnostic Procedure Result
Date: December 02, 2022 Consider Anembryonic Pregnancy
ULTRASOUND Minimal Subchorionic Hematoma (0.7 cc)
(Pelvic Ultrasound) Normal Sonogram of both ovaries
Clear Adnexae and CUL-DE-SAC
VII. Drug Studies/ Pharmacologic intervention w/ Analysis
Pharmacologic Analysis Nursing Responsibilities
Interventions
EVENING PRIMROSE The therapeutic activity • Assess V/S based on
OIL of evening primrose oil status to determine
(Everprim) is attributed to the worsening of the disease
CONTRAINDICATIONS direct action of its and response therapy;
•NONE REPORTED essential fatty acids on • Instruct patient to take
CAUTIONS: immune cells as well as drug as ordered;
•Concomitant Anesthesia to an indirect effect on • Observe for nausea and
•Schizophrenia the synthesis of vomiting;
•Seizure Disorder eicosanoids. • Take EPO with food or
liquid e.g. milk
Dosage: 4 grams • Do not take if pre-existing
Frequency: OD/Daily conditions such as
Side effects: epilepsy, blood disorders,
Pregnancy complication or seizures.
(Risk for postpartum • Evening Primrose Oil (Such
hemorrhage; e.g. as Eveprim) should have a
placenta previa) nutty smell and taste.
Adverse effects: Discontinue use if it smells
CNS: Headache bad or taste bitter.
GI: - Indigestion • Increase oral fluid intake if
-Nausea soft stools is noted.
-Soft stools • Do not use different
formulation of Evening
Primrose Oil at once.
• Stop taking primrose oil if
patient is for operation as
this may affect blood
clotting and may have a
risk for bleeding
• Avoid using eveprim
together with other
herbal/health supplements
that can also affect blood-
clotting. This includes
angelica (duong quai),
capsicum, clove, danshen,
garlic, ginger, ginkgo,
horse chestnut, panax
ginseng, or turmeric
