a pregnancy with no embryonic development, can present with vaginal spotting. However, it typically does not cause a uterine size-date discrepancy. Ultrasound shows an empty hypoechoic gestational sac (ie, gestational sac ≥25 mm with no embryo or yolk sac).
(AP) occurs as a result of early death and resorption of the embryo with further development of trophoblastic tissue, which produces β-hCG. Patients with AP can, therefore, have a positive urine pregnancy test initially and even develop features of pregnancy (e.g., areolar hyperpigmentation), but the expulsion of products of conception (POC) will eventually occur. AP is typically caused by chromosomal defects and is a common cause of early pregnancy loss , which would result in falling β-hCG levels. Vaginal bleeding and loss of pregnancy symptoms are possible manifestations. Depending on patient preference, AP can be managed expectantly, with misoprostol (to facilitate POC expulsion), or with vacuum evacuation.
The double decidual sac sign and intradecidual sign have a high positive predictive value for a true gestational sac. If no fetal pole is seen and the mean sac diameter is < 25 mm, wrong dating is a possibility, and follow-up TVUS is indicated; AP would then be diagnosed if no fetal pole is seen after 14 days (if the yolk sac was not visible on the initial TVUS) or after 11 days (if the yolk sac was initially visible).
A blighted ovum is an anembryonic pregnancy in which a fertilized egg attaches to the uterine wall, but the embryo fails to develop or is resorbed by the uterus, leaving an empty gestational sac. This commonly occurs early in pregnancy, so symptoms are often those seen in early pregnancy: a missed menstrual period, nausea, breast tenderness, and vaginal spotting. Ultrasonography will demonstrate the gestational sac without cardiac activity, as in this patient. It is usually caused by significant fetal chromosomal abnormalities. Management is supportive, since the mother will often pass the remaining gestational tissue without intervention. However, some women will elect to have dilation and curettage which may permit genetic analysis of the remaining tissue.
AP is diagnosed when there is no fetal pole in a true gestational sac ≥ 25 mm in size.