6 october 2012 Present by: Amir Zakwan Consulant: dr Cahyono SpOG (k)

Identity of Pasient Name:Mrs N Age:34 years old Address:Jatirojo 6/5 Kayen

Occupation: housewife Reg.number: 66.93.xx DOH:5 october 2012

anamnesis referred to this hospital after diagnosed having

blighted ovum by dr.Iwan Sp OG through ultrasound examination. Chief complaint:having vaginal spotting and abdominal cramp since yesterday. The pasient said that shes have been pregnant for 3 month

ANC History The pasient did pregnancy test and examine at the

bidan place twice and have been confirmed pregnant. The bidan ask her to check with the specialized docter. Checked to dr Iwan SpOg and referred to the hospital with blighted ovum

Menstruation cycle history The pasient mens was irregular,5-7 days with 30 days

cycle. Last menstruation period:20/7/2012 age of pregnancy: 11 weeks

Married History She have been married once and already 14 years. Her husband is 38 years old

Obstetric History Gravida=3 Para=1 Abortus=1

-the first child was a girl,12 years old and normal -having an abortion for the second pregnancy at the 3

month of pregnancy age.cause??? -this pregnancy

Other Diseases History DM(-) HT(-) Heart disease(-)

Allergy(-)

Family History ????

Physical examination General condition: compos mantis Vital sign: bp=110/70 mmHg

pulse=86x/mnt rr=20x/mnt t=afebris Eye: CA(-) SI(-) Thorax:cor and pulmo normal

Abdominal :

Inspect:distended(-)scar(-)trauma(-) auscult: peristaltic (+) perc: tymphany(+) palp: pain(-)

Supporting examination USG

Diagnosis Blighted ovum

management Termination of pregnancy by curretage Observation sign of hemorrhage Control to polyclinic

Discussion Blighted ovum

A blighted ovum (also known as anembryonic pregnancy) happens when a fertilized egg attaches itself to the uterine wall, but the embryo does not develop. Cells develop to form the pregnancy sac, but not the embryo itself.

is a pregnancy in which the very early pregnancy

appears normal on anultrasound scan, but as the pregnancy progresses a visible embryo never develops. In a normal pregnancy, an embryo would be visible on an ultrasound by six weeks after the woman's last menstrual period.

A blighted ovum causes about one out of two

miscarriages in the first trimester of pregnancy. A miscarriage is when a pregnancy ends on its own within the first 20 weeks. At about five to six weeks of pregnancy, an embryo should be present. At about this time, the gestational sac where the fetus develops is about 18 millimeters wide. With a blighted ovum, though, the pregnancy sac forms and grows, but the embryo does not develop. That's why a blighted ovum is also called an anembryonic pregnancy.

Causes Miscarriages from a blighted ovum are often due to

problems with chromosomes, the structures that carry genes. This may be from a poor-quality sperm or egg. Or, it may occur due to abnormal cell division. Regardless, body stops the pregnancy because it recognizes this abnormality. It's important to understand that the pasient have done nothing to cause this miscarriage and almost certainly could not have prevented it. For most women, a blighted ovum occurs only once.

Abnormal Zygotic Development.

Early spontaneous abortions commonly display a developmental abnormality of the zygote,embryo, early fetus, or at times the placenta. Of 1000 spontaneous abortions analyzed by Hertig and Sheldon (1943), half demonstrated degenerated or absent embryos, that is, blighted ova . Poland and co-workers (1981) identified morphological disorganization of growth in 40 percent of abortuses that were expelled spontaneously before 20 weeks.

Aneuploid Abortion.

Approximately 50 to 60 percent of embryos and early fetuses that are spontaneously aborted contain chromosomal abnormalities, accounting for most of early pregnancy wastage . Jacobs and Hassold (1980) reported that approximately 95 percent of chromosomal abnormalities were due to maternal gametogenesis errors and 5 percent to paternal errors.

Autosomal trisomy is the most frequently identified chromosomal anomaly associated with first-trimester abortions. Although most trisomies result from isolated nondisjunction, balanced structural chromosomal rearrangements are present in one partner in 2 to 4 percent of couples

with a history of recurrent abortions . Trisomies for all autosomes except chromosome number 1 have been identified in abortuses, but autosomes 13, 16, 18, 21, and 22 have been found most commonly.

Monosomy X (45,X), the second most frequent chromosomal abnormality, usually results in

abortion and much less frequently in liveborn female infants (Turner syndrome). Conversely, autosomal monosomy is rare and incompatible with life.

Triploidy is often associated with hydropic placental (molar) degeneration. Incomplete

(partial) hydatidiform moles may contain triploidy or trisomy for only chromosome 16. Although these fetuses frequently abort early, the few carried longer are all grossly malformed. Advanced maternal and paternal age does not increase the incidence of triploidy.

Tetraploid abortuses rarely are liveborn and most often are aborted early in gestation.

Sign and symptoms With a blighted ovum, pasient may have

experienced signs of pregnancy. For example, pasient may have had a positive pregnancy test or a missed period. Then you may have signs of a miscarriage, such as: Abdominal cramps Vaginal spotting or bleeding A period that is heavier than usual.

Criteria of diagnosed According to the Encyclopedia of Medical Imaging,

the criteria for a diagnosis of blighted ovum are: 1) failure to identify an embryo in a gestational sac measuring at least 20 mm via transabdominal ultrasound. 2) Failure to identify an embryo in a gestational sac measuring approximately 18mm or more via transvaginal ultrasound. 3) Failure to identify a yolk sac in a gestational sac measuring 13mm or more.

With embryo

management -dilatation and curretage. It may also be helpful if

want a pathologist to examine tissues to confirm the reason for the miscarriage. - Using a medication such as misoprostol on an outpatient basis may be another option. However, it may take several days for the body to expel all tissue. With this medication, pasient may have more bleeding and side effects. After a miscarriage, may recommend the pasient wait at least one to three menstrual cycles before trying to conceive again.