Anembryonic pregnancy (blighted ovum): diagnosis and options

Miscarriage UK describes missed miscarriage as one where the baby has died or not developed but has not been physically miscarried. In some cases the scan shows a sac with a baby inside but no heartbeat, and in others an empty sac or no clear sac. The charity says the embryo has either not developed or stopped developing at a very early stage and been reabsorbed by the body, and that you might hear this called early embryo loss, early embryonic demise, anembryonic pregnancy or blighted ovum.

The RCOG says an early miscarriage is usually diagnosed by ultrasound, either transvaginal or transabdominal or both, and that you may be offered blood tests, including the pregnancy hormone hCG. A transvaginal scan may be recommended because it gives a clearer image, and neither type increases the risk of miscarriage. You should be offered a chaperone for a vaginal examination or transvaginal scan.

Miscarriage UK says a missed miscarriage is often found at the routine dating scan between 11 and 14 weeks, or at the 20-week anomaly scan, but may also be found on any other scan, with or without symptoms. In the NHS description of miscarriage, sometimes you have no symptoms and find out only at a scan. Because there may have been no bleeding or pain, Miscarriage UK says pregnancy hormones can stay high so you may continue to feel pregnant and a pregnancy test may still be positive.

Sometimes a scan cannot settle the question on the day. The RCOG explains that some women will miscarry quite quickly but for others diagnosis and management may take several weeks, and the RCOG's guidance on early pregnancy bleeding describes a pregnancy of unknown location and repeat scans when a pregnancy is too early to see. Miscarriage UK quotes people who were asked to wait a week for a repeat scan, and describes this waiting period as feeling "in limbo". If you are being asked to wait, ask what you should watch for. The RCOG says to contact the early pregnancy unit or A&E immediately for heavy bleeding, severe abdominal pain, shoulder pain, dizziness or fainting.

The RCOG says that if some or all of the pregnancy tissue is still in the womb you can choose to wait and let nature take its course, use medicines, or have an operation. The NHS says that for early miscarriage options may include waiting (usually about 2 weeks but can take longer), taking medicine to help you pass the pregnancy, or a procedure using gentle suction under general or local anaesthetic. Which is best depends on your symptoms, preferences and clinical situation, and the choice is yours to discuss with your team.

The RCOG says you can expect bleeding for 1 to 2 weeks after a miscarriage, using sanitary towels rather than tampons, and that your next period will usually be in 4 to 6 weeks. Seek advice if you have heavy or prolonged bleeding with smelly discharge and abdominal pain, particularly with a fever and flu-like symptoms, which may be an infection of the womb lining (it says this occurs in two to three out of 100 women and can be treated with antibiotics). It also says tissue removed at surgery may be sent for testing to confirm the pregnancy was in the womb and to look for molar pregnancy, and that you may choose to bring pregnancy remains to hospital if you miscarry at home. If your blood group is rhesus negative, the NHS says an anti-D injection may be offered if you were at least 12 weeks pregnant.

The RCOG says there is a good chance of a successful pregnancy in future, since most miscarriages are one-off events. The NHS says to talk to a GP if you have had 3 or more miscarriages.

Miscarriage UK says the diagnosis can be heartbreaking, especially when there was no indication anything was wrong and you were looking forward to a scan, and that you may be asked to make decisions at the same moment you are coping with the news; some people feel ready quickly while others need a few days. The RCOG says miscarriage affects each person differently and can be devastating for partners too, and to talk to your GP if you are not coping. The NHS signposts Miscarriage UK and Tommy's, and says counselling and partner support are available. Local early pregnancy services and bereavement support vary across the UK.