Ultrasound
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Dx: Blighted Ovum

Within the uterus, you see a clear view of a gestational sac that measures almost 30 mm in its widest diameter. As you fan through, you do not see any evidence of a yolk sac or a fetal pole (above image).

The patient’s labs start to return and she has a quantitative hCG level of 3500 mIu/mL. With a quantitative hCG level that high, you would expect to see a yolk sac already.

Because the mean gestation sac measures >14 mm, and there is no visible yolk sac on the scan, it is likely that your patient has an anembryonic gestation or blighted ovum at this time.

You walk back into your patient’s room and pull up a chair so that you can have an uninterrupted conversation with her and her husband about her ultrasound findings. You hold her hand and explain to them that the ultrasound images obtained today suggest that she is having a blighted ovum in her uterus and that it doesn’t look promising for a viable pregnancy. You take your time to explain to her and her husband that it wasn’t anything they did wrong, and that it doesn’t mean they can’t try again in the near future. You reinforce that many couples have had miscarriages or a blighted ovum, and are still able to conceive and have beautiful, healthy babies in the future. Your nurse provides them with multiple pamphlets and references that they can read and refer to with any questions they may think of after they leave the ED. You recommend subsequent imaging in the next week or two to ensure that nothing else has progressed unexpectedly. The patient and her husband thank you for your time and empathy, and schedule their outpatient radiology and OB appointments as they walk out of your ED. It doesn’t appear as if your clinical black cloud is going to clear up anytime soon. You prepare for your next case with hopes of sunshine and silver linings.

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