What is an anembryonic pregnancy and how is it recognised? Diagnosis, waiting, medicine and surgery options, possible causes and what to expect afterwards.
An anembryonic pregnancy, commonly called an "empty pregnancy" in Turkish, is a type of early pregnancy loss in which the gestational sac forms but no embryo develops inside it. The womb is not "empty"; the pregnancy has stopped developing. The most common cause is a problem in the baby's chromosomes; very often no cause can be found. The process is planned together with your doctor according to your situation.
What does it mean when there is a gestational sac but the embryo has not developed?
When pregnancy begins, a gestational sac forms in the womb. In an anembryonic pregnancy this sac is present, but no embryo has developed inside it. Early pregnancy loss means the pregnancy has stopped developing, and it is very common. An anembryonic pregnancy is one of these types of loss.
What does the word "empty" fail to convey?
The word "empty" is used in everyday language, but it is misleading because it gives the impression that nothing was there. The pregnancy began and then stopped developing. This is a real loss, and the fact that the loss is early does not make the sadness smaller.
Does an anembryonic pregnancy cause symptoms?
An anembryonic pregnancy may cause no symptoms; sometimes the loss is found only on ultrasound. There may also be bleeding or pain. Bleeding and pain can be a warning sign, but not every bleed or pain means a pregnancy loss. A pregnancy that is not developing can also be noticed on ultrasound before bleeding begins.
Which examinations are done to diagnose it?
The diagnosis is made by ultrasound. The ultrasound can be done through the abdomen or vaginally; both are safe in pregnancy. In some cases a blood test measuring the hormone hCG is also requested.
Why might the ultrasound be requested again?
In the early period, even if a gestational sac is seen on ultrasound, it may not be possible to tell straight away whether the pregnancy is developing. In such cases the doctor may ask for the ultrasound to be repeated after a while, to avoid a healthy pregnancy being wrongly diagnosed as a loss. When the location of the pregnancy is uncertain, the blood test and ultrasound are repeated; a definite diagnosis can sometimes take time. This wait can be hard, but it is there so that the decision is not made in haste.
How is the possibility of an ectopic pregnancy assessed?
If there is pain or bleeding while the pregnancy test is positive, whether the pregnancy is inside the womb is also investigated.
What causes it?
The most common cause of early pregnancy loss is a chromosome problem in the baby; very often no cause is found. Age, diabetes, smoking, being very overweight or underweight and heavy alcohol use may increase the risk. Stress or sex has not been shown to cause early pregnancy loss; these are not proven causes. So there is no basis for a person who has had a loss to blame themselves.
How is the process managed?
There are three management options in early pregnancy loss: waiting, using medicine and a surgical method. Which one is suitable for you is determined according to your situation, your symptoms, your preference and the doctor's assessment.
What kind of option is waiting under a doctor's supervision?
In the waiting option, the pregnancy tissue is expected to leave the body by itself. If needed, the ultrasound is repeated during the process. Waiting is an option carried out under a doctor's supervision; it is not continued when urgent symptoms appear.
How is management with medicine planned?
In management with medicine, the doctor prescribes medicines that make the pregnancy tissue pass. The choice of medicine, its timing and how it is used belong to the doctor.
When might surgery be considered?
In the surgical method, the inside of the womb is emptied surgically by the doctor. This option may come to the fore, for example, when there is heavy bleeding or a sign of infection.
How is it decided which is suitable?
This decision is made together with the doctor according to the symptoms, the state of the bleeding, the features of the pregnancy, your medical history and your preference. You can ask your doctor about the advantages and risks of the options and the follow-up plan. Do not try to speed up the process on your own with medicine or herbal methods.
During this process, bleeding and cramping may be expected within the framework your doctor describes. If your doctor has given you instructions on when to come back that are specific to you, follow them as well.
What is expected afterwards?
After a pregnancy loss there is bleeding and cramping for a while. It is recommended that you use pads rather than tampons for the bleeding. Even if the bleeding has lessened, ask your doctor whether a check-up is needed.
Tell your doctor your blood group; if you are Rh negative, your doctor assesses whether anti-D is needed. After a pregnancy loss, ovulation can happen before the next period; so if you do not want to become pregnant again, talk with your doctor about contraception.
Can you get emotional support after the loss?
Pregnancy loss can cause intense feelings such as grief, sadness, anger and guilt. These feelings can be felt even when the loss is early. When needed, you can get help from a health professional or from support organisations. Sharing your feelings with the health professional who is following you is one way to reach the support you need.
How do you prepare for another pregnancy?
You can start trying to become pregnant again when you feel physically and emotionally ready; you can talk with your doctor about timing. It is also recommended that you take folic acid, adopt healthy living habits and avoid alcohol. Ask your doctor how and how much folic acid to take.
What questions can you ask your doctor?
- Ask what was seen on the ultrasound and whether any additional assessment is needed to confirm the diagnosis.
- Ask what the waiting, medicine and surgical options mean for your situation, their risks and the follow-up plan.
- Say your blood group and ask which measures or procedures are needed.
- Find out the expected course of the process and which symptoms mean you should come back straight away.
- Talk about when you can start trying for the next pregnancy and recommendations such as folic acid.
Frequently Asked Questions
What should I expect if medicine or surgery is chosen?
Management with medicine does not need an anaesthetic. The surgical method, on the other hand, can be done under general or local anaesthetic; its possible risks include bleeding, infection and injury to the womb. Your doctor decides with you which option is suitable.
Do one or two early pregnancy losses increase the risk in the next pregnancy?
One or two early pregnancy losses do not increase the risk of the next pregnancy. If you have had more than one loss, your doctor may plan an additional assessment. This information is not a guarantee; each pregnancy is followed in its own right.
Are my partner and those close to me also affected by a pregnancy loss?
Not only the pregnant person but also the partner, family and friends can be affected by a pregnancy loss. Grief is experienced differently by everyone.
Is the womb really empty in an anembryonic pregnancy?
No. The gestational sac has formed, but the embryo has not developed. The pregnancy began and stopped developing; this is a real loss.
Can an anembryonic pregnancy be noticed without bleeding?
Yes. It may cause no symptoms, and the loss may be found only on ultrasound. A pregnancy that is not developing can be noticed before bleeding begins.
Why might the ultrasound be requested again?
Development may not be clear straight away in the early period. To avoid a healthy pregnancy being wrongly diagnosed as a loss, your doctor may ask for another ultrasound.
Is every bleed or pain a pregnancy loss?
No. Bleeding and pain can be a warning sign, but not each of them means a loss. If you have these symptoms while the pregnancy test is positive, whether the pregnancy is inside the womb is also investigated.
Can I carry out the waiting option on my own?
No. Waiting is an option carried out under a doctor's supervision. It is not continued when urgent symptoms appear.
Can I speed up the process myself with medicine or herbal methods?
No. Do not try to speed up the process on your own with medicine or herbal methods. The method and the follow-up plan are determined together with your doctor.
Should I ask whether a check-up is needed even if the bleeding has lessened?
Yes. Even if the bleeding has lessened, ask your doctor whether a check-up is needed. Also tell them your blood group; if you are Rh negative, the doctor assesses whether anti-D is needed.
Can I become pregnant again before my next period?
Yes. After a loss, ovulation can happen before the next period. If you do not want to become pregnant again, talk with your doctor about contraception.
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