Gyn Chronicles
Pseudocyesis ( Phantom / Fake pregnancy )
By Dr . Maureen Owiti
Hello people ! In the era of fake news , let us delve into a serious but rare health problem such as pseudocyesis ( said sudosyesis diction : [ soo-doh-sahy- , ee , -seez ]). In my typical fashion I will demonstrate the illness in the form of a patient narrative .
A few years ago , around 2012 , I had just been posted to Thika level 5 hospital as it was then known . Not sure if the name has changed with County “ manenos ”. It was about 8.00am I had just arrived to do my morning ward round in labour ward , being the consultant on call that week . Immediately , I am met by the team leader and she is very frantic , there is a big problem ! She came to brief me that there is an “ expectant mother ” in labour but they cannot trace the fetal heart rate .
I immediately understood the gravity of the situation . Losing a baby is one of those things we do not love to witness . The pain of the mother after carrying a baby for nine months and not have the joy of taking it home is so heartbreaking to say the least . We are not allowed to show our emotions and I wish I could say we are trained to be empathetic , but these are skills one learns the hard way through trial and error . If there is an empathy trainer out there , please let us know and get in touch as many a doctor requires your services .
Not to mention the numerous reports and questions the midwives will go through if they have a fresh still birth at delivery . It is a challenge but , until now there is no other way to keep the midwives on their toes as they monitor labour , but the fear of writing those incident reports is alive . Back to my patient . I quickly put on my obstetrician hat and made my way to where the lady was being monitored . I introduce myself briefly and started to get the history from the horse ’ s mouth . The mother was Margaret Nyambura , obviously not her real name , she was 38 years old and this was her first pregnancy . She was more on the obese spectrum ( no offence meant as I am a member of that WhatsApp group ) and had been attending antenatal clinic at one of the near by dispensaries . From the Antenatal care ( ANC ) booklet the surveillance had been uneventful . She looked very uncomfortable and had the appearance of someone in active labour .
I enquired about the fetal movements and she reported that she still perceived them and had not noticed any change in the pattern . This information made me relax a little bit prior to doing my examination . Maternal perception of fetal movements is a very good indicator for fetal well-being .
I politely informed her that I wanted to examine the baby and fortunately did not disclose the nurses concerns and requested her to get on the examination couch . On initial surveillance her vitals were good with no major concerns on her general exam , so I swiftly proceeded without much further ado about nothing to examine her abdomen .
I followed the principles of abdominal exam and thankfully , there were no areas of tenderness ( pain ) and got to the obstetric exam . At this juncture , the first thing we always do is to establish the fundal height , which , in layman terms , is the size of the uterus . This gives a reliable approximation of the age of the pregnancy in singleton pregnancies .
Wonders will never cease !!! As I tried to establish the fundal height , I was unable to get the characteristic tipping sensation and before you know it , I was almost at the pubic region . For a term pregnancy this is quite unusual and if I was to go by the ANC booklet , which was not much use as some midwives hurriedly just give you “ palpable mass !” i . e . they can feel the uterus or a swelling in the abdomen and don ’ t give the exact size they are getting . It was also interestingly documented that fetal heart sounds were heard and regular .
I was not worried as it is sometimes difficult in larger women to examine and get accurate findings due to adipose tissue , otherwise known as body fat . I resorted to the secret weapon in such scenarios and proceeded to percuss the abdomen . Percussion is one of the examination techniques , different organ based on the amount of air in them produce different sounds and therefore it helps to establish if there is a problem , when a different sound from what is expected is heard . Air , which will be in the lungs and abdomen elicits a predominantly tympanic sound which is relatively long , high pitched , and loud . When it is not air i . e . solid or water / fluid , the sound becomes dull , which was my expectation over the pregnant uterus .
Low and behold , I again percussed and the entire abdomen was tympanic !!! Siku ilikua mrefu !!! In Swahili for those who may not understand : “ It was a long day !!” The conclusion of my examination was that , even if she was pregnant there was no way she was at term and completely impossible for her to be in labour . You can imagine me trying to explain this to someone , who for all intents and purposes had a fairly uneventful antenatal period . Whether she was having someone fill the details for her or it is just an error on the part of those examining is a story for
12 MAL61 / 24 ISSUE