April 6, 2010
Pseudocyesis - False Pregnancy
For the second time in my career as a labor and delivery nurse, I took care of a woman who said she was 28 weeks pregnant...but wasn't actually pregnant. She had everyone fooled. She came in by ambulance with several complaints and the only one OB related was abdominal pain. She wasn't happy to have been brought up to OB because she said she wasn't worried about the baby because she just had a sonogram a week ago and that he was moving all over the place. So I get to work to verify that she was fine obstetrically, but I was unable to find fetal hearttones. She was a larger woman, but appeared obviously pregnant. Her t-shirt appeared wet from leaking colostrum and when I did Leopold's, it felt like her baby was lying towards her left side. I grab a doppler, and again try to find the baby. No luck, but it sounds like there is movement in her abdomen. Generally, when you use a doppler to locate FHT's on a non-pregnant woman, or a woman with a fetal demise, you can hear her bowels moving, but it's pretty quiet. It really sounded like there was movement in there. I had 2 other people try - something I don't normally do because if I can't find FHT's, you worry it's a demise and all it does is stress the patient and the OB needs to come in. But I was sure I was hearing fetal movement. None of us had any luck. The patient didn't seem concerned because she said they have a hard time in the office, too. After trying for quite awhile, I call the city call OB (her OB doesn't practice at Hospital). He orders a OB sono to confirm the pregnancy is fine. At this point, I jokingly said to my coworkers "Maybe she isn't pregnant". But boy, was I surprised when the sono tech looked up and said "I don't see a pregnancy. I'll use the transvaginal to get a better look." Nope, nothing. Never was pregnant. No baby, no yolk sac, fetal pole, no nothing. Not even a large cyst. I wondered if maybe she had delivered recently and something happened and the baby died and she didn't tell anyone, but based on the report, it didn't appear she had been pregnant anytime recently. Not sure how they can tell that, but I'm not a sonographer. I felt pretty dumb because I really didn't think it was possible she wasn't pregnant. She had a large gravid-appearing abdomen, appeared to be leaking colostrum. And she insisted that she had a sonogram a week ago and everything is fine and then said "My babies never show up on the sonogram and they are fine". Complete denial. I believe she was the first case of pseudocyesis that I've seen. (The other case was someone who obviously knew she wasn't pregnant and she never let us evaluate her before she left AMA.) This woman was convinced she was pregnant and believed so whole heartedly that she appeared pregnant, had hormonal changes that cause colostrum to form and as for the "fetal movement", she must have some crazy gas in there. The "mass" was probably stool, hopefully nothing more serious. A couple times, I've felt gas moving around in my bowels that seriously felt like a baby running it's leg across my abdomen, when I was not pregnant. It was very eerie. I discharged her to the ER and I hope she sees a psychiatrist. We will be extra vigilant in the next few months with infant safety. People who claim they are pregnant but are not are at risk of trying to kidnap a baby. I'm still a bit in awe. I don't know what is going on in her life that she would claim to be pregnant, but I hope she gets the help that she needs.