One of the painful experiences a woman may go through after marriage is living the dream of pregnancy and motherhood for up to three months, only to be shocked that the pregnancy has ended. The doctor may diagnose it as a false pregnancy or an empty gestational sac—meaning that, despite experiencing all the early pregnancy symptoms (especially morning sickness), there was never a fetus inside the sac.
It is essential for pregnant women to make sure that the embryo is developing in the gestational sac in order to avoid the emotional distress caused by this condition. Dr. Hanan Al-Safi, Consultant in Obstetrics and Gynecology, explains the causes of an empty gestational sac, how to detect it, and whether it can recur.
How Does an Empty Gestational Sac Occur?
When a fertilized egg implants in the uterine wall, sometimes a developmental error prevents it from growing into an embryo. This condition is known as a blighted ovum (anembryonic pregnancy).
Although home pregnancy tests will still show a positive result, and the woman may experience typical pregnancy symptoms, the gestational sac develops without an embryo inside. Normally, by the 5th–6th week of pregnancy, a gestational sac containing an embryo should measure about 18 mm. In the case of an empty sac, it is eventually expelled naturally or through medical intervention within the first 20 weeks of pregnancy.
Possible Causes of an Empty Gestational Sac
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Chromosomal abnormalities in either the egg or sperm.
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Genetic or hereditary factors.
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Poor egg quality.
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Sperm defects.
This condition often happens during a woman’s first pregnancy and usually does not recur. Many women go on to have normal pregnancies afterward.
Symptoms and Warning Signs
Even without an embryo, the placenta may continue to grow and release hCG hormone, causing early pregnancy symptoms such as:
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Severe morning sickness (sometimes more intense than usual).
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Breast pain and bloating.
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Extreme appetite changes and food aversions.
If hormone levels remain high, symptoms persist even though no fetus is developing.
Warning signs that may indicate an empty sac include:
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Unusual or worsening abdominal and back cramps.
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Vaginal spotting or bleeding.
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Fatigue, dizziness, or fever.
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Excessively strong morning sickness.
The diagnosis is usually confirmed by ultrasound (sonography), which shows whether or not an embryo is present inside the sac.
Can It Be Prevented?
Since the exact cause is not fully understood, prevention is not possible. However, women with a family history of genetic disorders or consanguineous marriages (e.g., cousins) are advised to have early pregnancy monitoring with ultrasound to confirm normal fetal development.
Treatment and Management
Once an empty gestational sac is confirmed, there are two main options:
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Natural miscarriage – waiting at home for the body to expel the sac naturally through vaginal bleeding and uterine contractions as hCG levels drop.
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Medical or surgical management – the doctor may prescribe medication to induce miscarriage or perform a minor surgical procedure (dilation and curettage, D&C) to clear the uterine lining of remaining tissue.
⚠️ Important note: While the experience can be emotionally and physically painful, it usually does not affect future fertility. Many women are able to conceive again and carry a healthy pregnancy afterward.
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