Case Report

Blighted Ovum
Preceptor : dr. Hesty Duhita Permata, Sp. OG

Jenni Mutiara Saragih (202006010015)

Chapter #1
 INTRODUCTION

Definition miscarriage → WHO and

20% all pregnancies → abortion
80% EPL in 1st trimester
37,5% BO → at 10-13 weeks
CDC miscarriage is the loss of
pregnancy < 20 weeks or weights
less than 500 g

BO (anembryonic pregnancy) →
gestational sac (+), the embryo fails to
develop → 1st trimester
Chapter #2
 CASE REPORT
Identity
Name Mrs. R
Date of Birth / Age Oct 4th,1998 / 23 y.o
Address Kp. Pasir Pogor
Marital Status Married
Occupation Housewife
Religion Islam
Date of Examination April 6th, 2022
 Anamnesis
Chief complaint History of Present Illness

Vaginal bleeding one month

● Patient, gravida G1P0A0, found out that she was
prior to admission pregnant in mid-February. In the 7-8 weeks gestational
age, she had vaginal bleeding spots, from March 11,
2022. The bleeding is light and she didn’t use pad. The
colour of bleeding is red-brownish.

● She didn’t feel abdominal pain.

● She felt nauseous with a frequency of 5 times a day.

● 1st day of LMP : January 15th , 2022

 History
Previous Illness Medicine

Allergy, DM, Hypertension, asthma,

There is no medicine taking
kidney disease, heart disease → X

Family Illness Habitual

her mother had miscarriage of first

Smoking, drugs, alcohol → X
child (1990)
 Menstrual History
● Menarche : 11 years old
● Duration : 5-7 days
● 1st day of LMP : January 15th , 2022
● Amount : 2-3 menstrual pads/day, dysmenorrhea (-)
● Contraception :-

Obstetric History

● Marital History : 1st

● ANC : 1x in midwife
Physical Examination
General Examination
 Gynecologic Examination

● Inspection : external genitalia, perineum, and anus

are within normal. There are bleeding spots.
● Fundal height : not palpable
● Inspeculo : not performed
● Vaginal toucher
○ Vulva : within normal limit (there is no mass,
edema)
○ Vagina : within normal limit
○ Portio : thick portio, no dilation
○ Ostium uteri externum : closed
○ Corpus Uteri : bigger according to gestational
○ Blood (+), discharge (-)
 SUPPORTING EXAMINATION

Ultrasound
Examination
(2022/04/06)

Interpretation :
gestational sac (+),
diameter 2,6 cm, fetal
pole (-)
 Laboratorium Test (2022/04/06)

HEMATOLOGY
Result Normal Range
Hemoglobin 11,2 12-14 g/dL
Leucocytes 6,900 4,000-10,000/uL
Hematocrit 34 37-47%
Erythrocytes 3.9 3.8-5.2 million/uL
MCV 86.9 80-100 fL
MCH 28.4 26-34 pg
MCHC 32.7 32-36 g/dL
 Result Normal Range
Basophils 0 0-1%
Eosinophils 1 1-3%
Banded Neutrophils 0 0-4%
Segmented Neutrophils 65 50-65%
Lymphocytes 28 20-45%
Monocytes 6 1-8%
NLR 2.32 <3.13
ALC 1932 1750-3500
β-hCG Positive
Mrs. R, 23 years old, G1P0A0, gravid
13-14 weeks, with blighted ovum

DIAGNOSIS

Laminaria stiff and Curettage

TREATMENT PLAN
Chapter #3
 1
How is this case
diagnosed as a
blighted ovum?
 Anamnesis
Theory
● Early pregnancy loss → clinically
silent signs and symptoms.
● A late menstrual period.
● Bleeding per vaginam →light &
brownish or bright red in color.
● There may be mild backache or
dull pain in the lower abdomen5.
● Other symptoms of early
pregnancy, such as nausea,
vomiting, etc
Case
● Patient realised that she got
pregnancy in mid-February 2022.
● From March 11, 2022, patient got
light vagina bleeding and
red-brownish in color
● She didn’t feel abdominal pain
● She felt nauseous with a frequency
of 5 times a day.
 Physical Examination
Theory
● Inspection → bleeding may not
be found or there may be blood
spots.
● Inspeculo → to assess the
presence or absence of bleeding,
the vaginal walls, fluor albus, and
the portio vaginalis.
● Vaginal Toucher → to assess
vulva, vagina, portio, corpus uteri,
and presence or absence blood.
Case
● Inspection → bleeding spots.
● Inspeculo : not performed →
inspeculo is important exam for
finding source of bleeding.
● Vaginal Toucher → vulva is within
normal (there is no mass, edema),
vagina is within normal.
 Supporting Examination
Theory
● Ultrasound exam (transabdominal
or transvaginal) classically
demonstrates an empty
gestational sac, diameter of ≥25
mm, without an embryo1 .
● At 7-8 weeks of gestation if the
ultrasound examination give
characteristic of anembryonic
pregnancy → necessary to do an
ultrasound evaluation 2 weeks
later8.
Case
● April 03, 2022, patient got first
ultrasound exam in Klinik Sehat.
There were no embryo seen in a
gestational sac with ≥27 mm.
● April 06, 2022, second ultrasound
exam, there were gestational sac
(+), diameter 2,6 cm, fetal pole
(-).
 2
What are differential
diagnoses in this
case?
 DD/ Definition
Missed Abortion When the fetus is dead
before 20 weeks and
retained inside the
uterus for several weeks
after the fetus died
Anamnesis Physical Exam.
● bleeding (+)/(-) ● OUE will be closed
● may be mild or opened
backache or dull ● Uterine size is
pain in the lower smaller than g.a
abdomen ● (+/-) vaginal
bleeding

Imminent abortion occurs at <20 - light vaginal - OUE is closed

Abortion weeks of gestation, bleeding - Uterine size is
(Threatened bleeding is usually not - mild abdominal according to
Abortion) heavy, has just begun to pain gestational age
threaten, and there is still
hope to keep the
pregnancy.
 3
How is the
management in
this patient?
 Expectant management Medical management Surgical Treatment

Not recommended for EPL → initial treatment Dilation and Curettage →

blighted ovum → using 800 micrograms of Curettage, is
incomplete EPL tend to vaginal misoprostol is recommended for
report higher success recommended gestation ≤15 weeks9
Chapter #4
 Conclusion

● The diagnosis for this patient is appropriate for anamnesis, physical

examination, and ultrasound examination which confirm the
diagnosis.
● Differential diagnosis for blighted ovum are missed abortion and
imminent abortion
● The treatment plan for this patient is appropriate, that is dilation and
curettage.

Suggestion

There should be a speculum

examination for evaluating the source
of bleeding
 REFERENCES
1. Chaudhry K, Tafti D, Siccardi M. Anembryonic Pregnancy [Internet]. Ncbi.nlm.nih.gov. 2022 [cited 9 May 2022]. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK499938/
2. Sulistyowati S, Rahadian F, Respati S, Soetrisno S. Blighted Ovum: Roles of human leukocyte antigen-E and natural killer cells. Bali
Medical Journal. 2017;6(2):381.
3. ZA R, Rosdiana E. Faktor-Faktor yang Mempengaruhi terjadinya Blighted Ovum (BO) pada Ibu Hamil di Rumah Sakit dr. Zainoel Abidin
Kota Banda Aceh Tahun 2015. Journal of Healthcare Technology and Medicine. 2019;2(2):135.
4. Dugas C, Slane V. Miscarriage [Internet]. Ncbi.nlm.nih.gov. 2022 [cited 9 May 2022]. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK532992/
5. Konar H. DC Dutta's Textbook of Obstetrics. 9th ed. India: Jaypee Brothers Medical Publishers; 2018.
6. Ectopic Pregnancy [Internet]. Acog.org. 2022. Available from: https://www.acog.org/womens-health/faqs/ectopic-pregnancy
7. Mummert T, Gnugnoli D. Ectopic Pregnancy [Internet]. Ncbi.nlm.nih.gov. 2022. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK539860/
8. Prawirohardjo S. Ilmu kebidanan. 4th ed. Jakarta: Yayasan Bina Pustaka; 2010.
9. Williams J, Cunningham F, Leveno K, Bloom S, Hauth J, Gilstrap L et al. Obstetrics. 24th ed. United States: McGraw-Hill; 2015.
10. Ghassemzadeh S, Farci F, Kang M. Hydatidiform Mole [Internet]. Ncbi.nlm.nih.gov. 2022. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK459155/
11. ACOG Practice Bulletin No. 200: Early Pregnancy Loss. Obstetrics & Gynecology. 2018. 132(5):e197-e207.
12. Martaadisoebrata D, Wirakusumah F, Effendi J. Obstetri Patologi: Ilmu Kesehatan Reproduksi. 3rd ed. Jakarta: Buku Kedokteran
EGC; 2012.
Many thanks!
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