In Kenya specifically, about 10 per cent of all pregnancies end in miscarriage according to the 2022 Kenya Demographic and Health Survey. This includes cases of blighted ovum among other pregnancy complications.
When Stella Nalo’s pregnancy test turned positive, she was ecstatic.
“I had always dreamed of having a honeymoon baby. Just a month after our wedding, I noticed my period was late. I was so excited that I bought three pregnancy kits from a pharmacy in my neighbourhood. I rushed home, took the test, and waited with bated breath to see the second line.”
There it was, faint, but there alright. When her husband got home from work, she was already waiting at the door, eager to share the news.
“He was so happy that he hugged me and spun me around. I laughed and told him to be careful not to squish the baby. It was such a silly, joyful moment. I felt blessed and couldn’t wait for my first prenatal clinic later that week.”
Her husband joined her at the hospital, but the appointment was less exciting than she had imagined.
“The sonographer told me to come back in three weeks because there wasn’t much to see yet. He even had to do a transvaginal ultrasound, which was cold and uncomfortable, but still nothing showed. He reassured me that it was simply too early and promised we’d see something at the next visit.”
On their way home, Stella noticed her husband was unusually quiet. However, she didn’t feel like talking much either, still sore from the procedure and unsure of what to expect in the next appointment.
Time passed quickly, and soon it was time for her second appointment. Unfortunately, her husband couldn’t make it because of work.
“I remember teasing him that I would get to see our baby before he did. I even joked that if they were twins, I wouldn’t tell him. My tummy felt bloated, so I wore a loose dress. At the clinic, as I lay on my back and tilted my head to watch the screen, I noticed something odd. The sonographer kept adjusting the device, his eyebrows creased as if deep in thought. Just as I was about to ask, he told me something was wrong, the pregnancy wasn’t growing.”
Stella froze. The sonographer explained that the doctor would clarify everything and stepped out, leaving her to get dressed.
“I called after him, asking if the baby was okay. He came back and quietly said there was no baby—that there had never been one. I opened my mouth to speak, but he gently repeated that the doctor would explain further.”
Stella’s eyes welled up with tears as she texted her husband. Within half an hour, he rushed to the hospital, just in time to meet the doctor with her.
“When the doctor looked at the scans, his expression changed. He explained that I had a blighted ovum. My body had created a pregnancy sac, but the baby never developed. He said medication could clear it out safely, and that we could try again after a month. I sat there in shock, barely able to process his words. I felt an overwhelming grief. How do you mourn a baby who, in truth, was never there?”
Dr Stephanie Koga, a consultant obstetrician and gynaecologist based in Nairobi, explains that a blighted ovum, also called anembryonic pregnancy, occurs when a fertilised egg implants in the uterus but fails to develop into an embryo, which is the baby.
“There are usually chromosomal abnormalities that occur during the combination of maternal and paternal DNA that are lethal and thus hinder further development of the embryo (baby). A blighted ovum is considered a very early demise of an embryo before it even develops its human organs and tissues.”
But why does a pregnancy test show positive if there is no baby? Dr Stephanie explains,
“After the demise of the embryo, tissues that usually surround the baby as it develops are what remain and produce the hormone of pregnancy called beta human chorionic gonadotrophin (β-HCG). Therefore, a pregnancy test will confirm the presence of a pregnancy, but the ultrasound will show a sac without the embryo (blighted ovum). This indicates that the pregnancy is not viable and ends in a miscarriage.”
She further notes that blighted ovum accounts for nearly 50 per cent of all first-trimester miscarriages and may occur in as many as 15 per cent of all pregnancies. In Kenya specifically, about 10 per cent of all pregnancies end in miscarriage according to the 2022 Kenya Demographic and Health Survey. This includes cases of blighted ovum among other pregnancy complications.
Reducing the risk
Many times, when a pregnancy goes wrong, the couple, more so the expectant mum, wonders if they did something to cause a miscarriage. However, in the cases of a blighted ova, Dr Stephanie emphasises that most of them result from random genetic errors and cannot be prevented.
“However, the risk can be reduced through preconception care that involves an evaluation by a gynaecologist before conception and proper management of pre-existing conditions such as thyroid disorders, diabetes and autoimmune diseases that may affect the pregnancy. Lifestyle changes such as stopping alcohol consumption and smoking, a healthy diet and regular exercise to maintain weight around the recommended range for your height, as well as folic acid supplementation, can help reduce the risk.”
Dr Stephanie notes that chronic stress can disrupt hormonal balance, potentially affecting reproductive health. Additionally, couples with recurrent pregnancy losses (more than three consecutive miscarriages) need advanced evaluation to determine the causes and required interventions.
How is a blighted ovum diagnosed?
“A pelvic ultrasound that shows a sac with no embryo by the 8th week of pregnancy, in addition to a positive pregnancy test, is diagnostic for a blighted ovum. Every stage of pregnancy has recommended levels of the pregnancy hormone β-hCG in the woman’s blood. If low levels of beta hCG are detected in the blood, it can raise suspicion of a blighted ovum, but only ultrasound examination can confirm the diagnosis. An ultrasound should be done as early as the pregnancy test is confirmed positive,” says Dr Stephanie.
Once the diagnosis is confirmed, the next step is seeking treatment. Dr Stephanie explains there are three ways to do this, depending on the patient’s clinical condition and preference.
“The first option iswaiting several weeks for a spontaneous miscarriage by one’s own body. The body can recognise that a pregnancy is not viable and initiate the process of miscarriage. However, waiting does not mean that the pregnancy will continue growing or change to become viable.
Another option is taking medicines that initiate the evacuation of the pregnancy by opening the cervix and causing contractions of the uterus. We have drugs like Mifepristone and Misoprostol in the Kenyan market. These should be prescribed by a qualified healthcare provider to ensure they are used safely.
The third option is a surgical procedure to evacuate the pregnancy manually. We commonly perform a procedure called manual vacuum aspiration (MVA) that suctions out the products of conception. Again, this should also be done by a qualified healthcare provider to ensure safety and mitigate complications.”
Blighted ovum represents genuine pregnancy loss requiring acknowledgment and psychosocial support. Like Stella, many women experience grief, disappointment, anxiety about future pregnancies, and may blame themselves despite the condition being beyond their control.
But here is some good news:
“Having a blighted ovum does not change the chances of successful future pregnancies. Most women experience a blighted ovum only once. Future fertility and pregnancy outcomes are generally excellent,” says Dr Stephanie.
How to support grieving families – By Dr Stephanie Koga
Losing a pregnancy is very upsetting, and emotional support during and after this process is essential. Some of the ways to support affected families include:
- Validate the loss: Acknowledge this as a real pregnancy loss, not "just" a missed period
- Provide emotional support: Listen without offering immediate solutions
- Avoid blame or questions about cause: Emphasise this is not caused by anything the woman did
- Encourage professional support: Counselling or support groups when needed
- Respect grieving timeline: Allow individual processing without pressure to "move on"
- Time off work: there is a bill currently in parliament to legislate the need for a special leave from work, like maternity leave, for women who have experienced any kind of pregnancy loss. Employers should support these women by allowing them sufficient paid time off work.
Most practitioners recommend waiting at least 1-3 regular menstrual cycles before attempting conception, allowing for physical uterine recovery, emotional healing and nutritional repletion (especially folate stores). This, however, does not restrict those who want to conceive immediately. It is good to discuss this with your gynaecologist to better determine the support you need.
Lastly, the reason a blighted ovum happens is often unknown but may be due to problems with chromosomes in the fertilised egg. Most cases represent the body's natural mechanism for preventing chromosomally abnormal pregnancies from progressing, and women should be reassured that this reflects normal biological processes rather than personal failure.
Dr Stephanie Koga is consultant obstetrician and gynaecologist based in Nairobi.
