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
OIL of evening primrose oil
(Everprim) is attributed to the
CONTRAINDICATIONS direct action of its
•NONE REPORTED essential fatty acids on
CAUTIONS: immune cells as well as
•Concomitant Anesthesia to an indirect effect on
•Schizophrenia the synthesis of
•Seizure Disorder eicosanoids.
Dosage: 4 grams
Frequency: OD/Daily
Side effects:
Pregnancy complication
(Risk for postpartum
hemorrhage; e.g.
placenta previa)
Adverse effects:
CNS: Headache
GI: - Indigestion
-Nausea
-Soft stools
• Assess V/S based on
status to determine
worsening of the disease
and response therapy;
• Instruct patient to take
drug as ordered;
• Observe for nausea and
vomiting;
• Take EPO with food or
liquid e.g. milk
• Do not take if pre-existing
conditions such as
epilepsy, blood disorders,
or seizures.
• Evening Primrose Oil (Such
as Eveprim) should have a
nutty smell and taste.
Discontinue use if it smells
bad or taste bitter.
• Increase oral fluid intake if
soft stools is noted.
• 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