another day , as here we had a mother , who on all counts could not possibly be in labor .
Cardinal sin number one for me unfortunately is that I do not know how to hide my emotions and I tell things as they are . I gave the report of my findings to Margaret and as would be expected the initial response was obviously denial and that my examination was wrong . She was not interested in my credentials and was not hearing anything I had to say and became hysterical .
Finding myself in a rather tight spot , I had to do something to calm her down and convince the mother of my findings . To allay her feelings and suspicions , I conceded that maybe my findings were wrong but we could easily resolve the situation by doing an Ultrasound . All I requested was that we both be satisfied with the results of the imaging . Having struck a bargain , I requested one of the Medical Officer Interns to do the requisition as we completed the ward round . Just as we were finishing the round the primary nurse informed me that the imaging results were out if I could go and review the patient .
Surprise ! Surprise ! The uterus was not gravid i . e . she was not pregnant . The radiographer had not disclosed his findings so it was up to me to again inform her of the findings . The mother was very dismayed with the findings and forgot our agreement . It took a lot of talking to using all the Kiswahili we knew and when it was evident we were heading nowhere , we had to call in the counsellor to have a chat with her .
It turned out she had been married for several years and had been trying to conceive . The husband had actually taken on a second wife , with whom he had two children and she was desperate to have a child . We left her in the capable hands of the psychiatric team and asked her to come in for an evaluation in the gynaecolgy clinic .
This is one of those experiences you never forget and I can clearly visualize “ Margaret ” and the examination room , when writing this story . Unfortunately , she is not alone in this phenomenon and for it to have a name there are several such women . In recent history the first highly detailed record of such a case is Queen Mary .
In April 1555 , Queen Mary 1 - better known in history as “ Bloody Mary ” - went into seclusion as she awaited the birth of her first child . At 38 , the eldest daughter of King Henry VIII desperately needed an heir , preferably male , to secure an alliance with Spain and continued Catholic rule in England . The stakes were high .
Still , both Mary and the nation were optimistic . The year after she ' d married Philip II of Spain , the Queen looked pregnant : Her breasts and belly had swelled , and she reported morning sickness and movement in her womb . As such , the nursery was prepared , wet nurses were on call , and announcement letters were prepared and signed , leaving just the date of delivery and sex of the child to be filled in .
Yet “ as the weeks passed , the mood became one of despair ,” writes Anna Whitlock , author of Mary Tudor : Princess , Bastard , Queen . Rumors spread the Queen was dead , or that the child had died , and another would be swapped in its place .
The truth was less scandalous : Despite all appearances to the contrary , Mary had never been pregnant to begin with , having the misfortune of being history ’ s first well-documented case of a very rare phenomenon called pseudocyesis . The excerpts referenced here-in on Queen Mary have been duly taken from National Geographic : https :// www . nationalgeographic . com / science / article / phantom-pregnancy-pseudocyesis-mentaldisorder
There are three terms closely related that |
should not be confused : Pseudocyesis , |
Pseudopregnancy |
and |
Delusion |
of |
pregnancy . |
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Pseudocyesis : an erroneous belief of being pregnant that is associated with physical signs of pregnancy .
Pseudopregnancy ( erroneous pseudocyesis ): A medical condition ( e . g . ovarian cyst / fibroids ) that produces physical symptoms associated with pregnancy that are falsely interpreted as a true pregnancy . Once the medical cause for symptoms is found , the patient typically no longer believes that she is pregnant .
Delusion of pregnancy ( sometimes referred to as psychotic pregnancy ): a delusional disorder often seen in psychotic illness without any physical manifestations of pregnancy .
Causes or risk factors for pseudocyesis
• Strong desire to become pregnant
• Multiple miscarriages
• Loss of a child
• Infertility
• Extreme fear of becoming pregnant
• Depression or anxiety
• Emotional trauma
• Sexual abuse
Once diagnosed treatment usually involves multi-disciplinary approach to care . We must rule out organic causes i . e . make sure there is no illness causing these symptoms such as fibroids , thyroid disease , diabetes , ovarian cysts and so on . Counselling would be the main stay of treatment and if necessary , referral to psychologist for psychotherapy . If all else fails then the next step would be a good psychiatric evaluation .
Some patients will require psychotropic medication . For those women with menstrual irregularities restoring menstruation is very helpful . In all pathology never forget to Treat contributory medical conditions and Involving family and friends is very useful for rehabilitating the patient .
Fast-forward , it turned out Margaret had thyroid disease and is now blessed with a beautiful baby girl . Sorry for the long column but I hope this will bring to light this rare condition and help us all to be empathetic to women who suffer from this rare condition .
Dr . Maureen Owiti is a practicing Obstetrician Gynaecologist and fertility consultant based in Nairobi . You can commune with her on this or related matters via email at : Drmaureenowiti @ gmail . com