Pseudocyesis – The false pregnancy
EARLY last week I received the following call from the labour and delivery suite: “Dr Daley, we have a patient who says she is 33 weeks pregnant, but we are not feeling a uterus, appreciating foetal movement or getting a foetal heart. Can you please come and assess.”
A rare condition lingered at the back of my mind. After a full assessment, my diagnosis of this rare condition was confirmed — pseudocyesis: false pregnancy.
Pseudocyesis can cause many of the signs and symptoms of pregnancy, and often resembles the condition in every way… except that there is no foetus. It is a rare condition and dates back to 300 BC when the father of medicine — Hippocrates — identified 12 cases. Another example is the Queen of England — Queen Mary Tudor — who claimed to be pregnant in 1555, but she was not.
Signs and symptoms
The symptoms are similar to those of pregnancy and are hard to distinguish. Patients will have morning sickness, weight gain and breast tenderness. Women with this condition are convinced they are pregnant, and most women actually do have abdominal distension — with the abdomen actually expanding as if it contained a pregnant uterus. This is thought to be caused by a build-up of gas, faeces or urine. Women also experience menstrual irregularity, so months will go by without a period, as in a genuine pregnancy. To make the scenario even more strange, some women claim to perceive foetal movement.
Causes
There is no identifiable cause. One theory suggests that a woman’s intense desire to become pregnant can impact on the endocrine system causing the signs and symptoms of pregnancy.
Another theory is that if a woman believes she is pregnant she will interpret minor changes in her body as a pregnancy.
A final theory is that of depression, where chemical changes in the brain will trigger symptoms of pregnancy.
Pseudocyesis is more common in women who have had multiple miscarriages and unsuccessful pregnancies. Examination may reveal a normal uterus with or without abdominal distension. Confirmation is made with a negative pregnancy test and a non-pregnant uterus on ultrasound.
Treatment
No definitive medicine can be prescribed for this condition. Patience, empathy and reassurance must be expressed to these patients as there are usually underlying social, psychological and emotional causes. The most effective treatment for these patients is psychiatric care and adequate counselling. In some cases, the only way to convince patients that they are not pregnant is by the use of ultrasound or other imaging techniques.
Dr Daryl Daley is a consultant OBGYN at Gynae Associates, 23 Tangerine Place, Kingston 10, and shops 46-50, Portmore Town Centre. He can be reached at 929-5038/9, 939-2859, 799-0588 or drdaryldaley@gmail.com
Dr Daryl Daley is a consultant OBGYN at Gynae Associates, 23 Tangerine Place, Kingston 10, and shops 46-50, Portmore Town Centre. He can be reached at 929-5038/9, 939-2859, 799-0588 or drdaryldaley@gmail.com
