No fetal heartbeat/pole Case Study
Patient Signs and Symptoms, History, and Physical Exam
The patient is a 25-year-old female who believes she is about seven weeks pregnant based on her last menstrual period. Her home pregnancy test, which she took three weeks ago, was positive. This is her second pregnancy which was planned and welcome. She presented with bright-red vaginal bleeding, which was lighter than a menstrual. She admitted to some mild to moderate cramping in her abdominal area but denied any uterine cramping. She also reported her last intercourse was more than six days ago. Also, she denied fever, burning, itching, or changes in discharge preceding the onset of her symptoms. The patient also reported a feeling of dizziness and nausea but no vomiting. The patient’s blood pressure was 110/67 mm Hg, pulse 78 beats/minute, and temperature of 97.4F. The patient was concerned since her first pregnancy did not have any complications.
Diagnostic Test and Results
Since the patient was in the first trimester, which is considered very fragile and is the period when most miscarriages and defects occur, it was agreed that screening is performed to check if the fetus was at any risk. A vaginal ultrasound was performed to check for the presence of a fetal pole/heartbeat. A fetal pole is a thickening on the margin of the fetus’ yolk sac and its presence is an indication of a healthy pregnancy. The transvaginal ultrasound results showed MSD of >25 mm with an absent fetal pole. Clinically, when MSD measures ≥25 mm, the fetal pole is supposed to be visible, which indicates a healthy pregnancy (Mizia et al. 181). Since results for the patient showed MSD of >25 mm with an absent fetal pole, this indicated pregnancy failure. The differential diagnosis for the patient included ectopic pregnancy and a blighted ovum.
A transvaginal ultrasound scan was carried out, and results were reported along with beta Subunit Of Human Chorionic Gonadotropin (hCGβ) levels. A small probe was inserted in the patient’s vagina that emitted sound waves that bounced back, creating a close-up image of the patient’s reproductive system on the monitor. Results showed that the fertilized egg was implanted in the uterine lining and not in one of the patient’s fallopian tubes. The hCGβ levels were about 100,000 mIU/mL. Clinically, the standard diagnosis of a patient with ectopic pregnancy is measurements of hCGβ levels above the discriminatory zone of 1500–2000 mIU/mL (Chen et al. 2476). Therefore, the results for ectopic pregnancy were negative.
Also, the virginal ultrasound showed that the gestational sac was empty; thus, the patient was diagnosed with a blighted ovum. A blighted ovum refers to a condition whereby the fertilized egg implants on the uterine wall but fails to grow into an embryo. The placenta and gestational sac grow, but since the embryo is not growing, the gestational sac remains empty (Chaudhry and Siccardi para 1). Usually, a blighted ovum is caused by genetic or chromosomal problems during cell division. It is the most common cause of miscarriages during the first trimester of pregnancy. A miscarriage is the loss of pregnancy before twenty weeks of gestation. Signs and symptoms of blighted ovum include vaginal bleeding or spotting and abdominal cramping.
A blighted ovum is related hydatidiform mole. Hydatidiform mole refers to an anomaly of the conceptus whereby the changes that begin taking place during early pregnancy/early embryonic life lead to the placenta villi becoming blisters filled with watery or gelatinous fluid or mass of transparent, thin-walled vesicles (Candelier 226). Consequently, this affects the blood flow in the uterus, where the uterus receives minimal blood flow. The absence of the blood arteries in the placenta villi, which is as a result of the failure of the embryo to grow, along with continued growth and frequent enlargement of the trophoblast, is the primary condition that leads to the hydatidiform mole. The villi become distended by fluid as a result of the trophoblast’s continuous activity in the absence of healthy villous circulation.
Interpretation of Results and Lab Data
The diagnostic test performed was transvaginal ultrasound. The Mean Sac Diameter (MSD) was measured, which was results showed an MSD of >25 mm. The fetal pole was looked for since the fetal pole is among the first structures that can be seen on an ultrasound during early pregnancy. However, a fetal pole was not spotted during the examination. The patient was told to wait for three days, and another ultrasound was done. Still, the fetal pole was missing. Since MSD measures ≥25 mm with no fetal indicates a pregnancy failure, it was concluded that the patient had a pregnancy failure, and further ultrasound was performed to further examine the problem. Ectopic pregnancy results were negative. However, the gestational sac was empty, indicating that the patient had a blighted ovum.
Treatment and Medications
There are three treatment options for blighted ovum: surgical treatment, expectant management, and medical management (Chaudhry and Siccardi n.p). The expectant management entails waiting for the miscarriage to occur naturally. When using this treatment option, the patient is followed without any intervention for complete and spontaneous passage of tissue. On the other hand, medical management entails administering misoprostol to the patient to induce miscarriage. The surgical treatment option involves the evacuation of the uterine with a manual vacuum. Notably, medical management with misoprostol administration and surgical management are the most effective management options for blighted ovum. The two options were applicable to the client, and the patient opted for medical management. 800 mcg of misoprostol was administered to the patient through the vagina.
Follow-Up and Prognosis
The patient was supposed to visit the clinic for a check-up to ensure complete passage of tissues. Transvaginal ultrasound was performed to check for any conception products in the uterus after an agreed period when the patient was expected to have completed the passage of tissues. The patient’s prognosis is generally good. This is because the patient was administered several doses of regimens of misoprostol, ensuring that no conception products would be left in the uterus. Research reveals that Misoprostol alone is safe and effective, as well as a reasonable option for women who abort during the first trimester (Raymond et al. 137).
Candelier, Jean-Jacques. “The hydatidiform mole.” Cell adhesion & migration 10.1-2 (2016): 226-235. https://doi.org/10.1080%2F19336918.2015.1093275Chaudhry, Khalid, and M. A. Siccardi. “Blighted Ovum (Anembryonic pregnancy).” (2018). https://europepmc.org/article/med/29763113Chen, Chen-Yu, et al. “Quantitative analysis of total β-subunit of human chorionic gonadotropin concentration in urine by immunomagnetic reduction to assist in the diagnosis of ectopic pregnancy.” International Journal of Nanomedicine 10 (2015): 2475-2483. https://doi.org/10.2147%2FIJN.S81201Mizia, Karen, et al. “Guidelines for the performance of the first-trimester ultrasound.” Australasian Journal of Ultrasound in Medicine 21.3 (2018): 179-182.
Raymond, Elizabeth G., Margo S. Harrison, and Mark A. Weaver. “Efficacy of misoprostol alone for first-trimester medical abortion: a systematic review.” Obstetrics and gynecology 133.1 (2019): 137-147. https://doi.org/10.1097%2FAOG.0000000000003017