A midwife woke me at 1.30am this morning to tell me that a patient of mine had presented to the birth unit and told the midwife she was 26 weeks pregnancy with twin pregnancy. She went on to say the patient woman had had an ultrasound scan the day before (Saturday) and was told by the ultrasound unit staff one twin had died. The midwife checked with a CTG monitor and advised me she could not find a foetal heart.
She said the woman told her she had preeclampsia that was being managed by her GP. She said she did not have an antenatal card and that she had only seen me once in my rooms. That she gave the midwife my name is the reason the midwife called me.
I advised the midwife the woman’s story was unusual to say the least. I did not recall a patient who was currently 26 weeks with twins or a patient with this woman’s name. I logged into my office computer. I did not have patient who had her surname and Christian name, or a with her surname and different Christian name or with her Christian name and different surname who was currently pregnant. I advised the midwife accordingly. I said I had no record of her being my patient. Furthermore, she should have an antenatal card, I would have seen her more than once, GPs do not manage preeclampsia and routine ultrasound scans are not done on Saturdays and I would have been phoned by the ultrasound unit if a patient I referred to them had foetal demise.
I asked the midwife if her uterus was enlarged. She said she was not sure as she was a very large woman, and she was not confident she could feel the uterus. She also said the woman, the family friend who accompanied her and her mother were all intoxicated.
She told the midwife she had the ultrasound scan report on her phone. When the midwife asked to see the report, the woman said she was mistaken, and it must be on her computer at home.
I advised the midwife I did not believe the woman was actually pregnant. If this was the case the background to this is a mystery. Why she mentioned my name is mystery. It was most likely she has heard about me or read online about me. To my knowledge I have never met this woman.
The midwife encouraged her to go to the A&E department for further assessment. If this woman had attended A&E and ultrasound scan could have been arranged to confirm her pregnancy.
She said the woman then became extremely aggressive and left the hospital. She did not attend A&E.
I am confident from the presentation information this woman most likely had pseudocyesis, or a false pregnancy. It is also called a phantom pregnancy. With pseudocyesis, a woman can have pregnancy symptoms and consider they are pregnant, however pregnancy tests and ultrasounds will confirm they are not physically pregnant, and there is no foetus is growing in their uterus. It could be her realisation she was being not admitted to the birth unit and that an ultrasound scan would confirm she is not pregnant that prompted her aggression toward the staff and her decision to leave the hospital instead of attending A&E.
Pseudocyesis is a rare condition. It is reported there are between 1 to 6 cases per 22,000 births. Mental health issues and hormonal factors play a role in causing it.
