Women Talk: Ghost pregnancies—eerie but true

Sandy was a 37-year-old housewife from Binalbagan, Negros Occidental, who came to the clinic for a “prenatal check-up.” History revealed that she has been married for seven years to a 40-year-old IT specialist. 

 

They had been trying to have a child, and had enrolled in fertility workups with several doctors, without success. For the past few months, in-laws had been putting pressure on her to have a child, especially because her husband is the only son in the family. 

 

Suddenly Sandy missed two menstrual periods, although her menses had never been regular. For the past week too, she noticed nausea upon waking up and even vomiting. With this her dresses and pants seemed to have gotten tighter, and her abdomen bigger. She felt that this was it, the longed-for baby. She felt that a pregnancy test at home was no longer necessary, and instead sought consult.

 

On pelvic examination, however, there were no changes in the consistency of her cervix (which usually becomes very soft because of the pregnancy hormones), and even with two months missed period, her uterus was neither soft nor enlarged. True, her abdominal fat became thicker, which made the dresses tighter. But I had to tell her the sad news: I was not convinced that she was pregnant. 

 

A pelvic ultrasound done later showed that indeed there was no pregnancy, and we had to regulate her irregular menses. 

 

Flashback to so many years ago when I was just starting my OB-GYN practice: One of my very first private patients was a 35-year-old fish vendor from Cavite who had two prenatal consults with me. She was supposed to be in her fifth month (counted from her last menses), and was already wearing maternal dresses. She was an obese lady, but when she said there were still no fetal movements, an alarm rang in my mind. 

 

Ultrasound then was in its infancy, and done by radiologists, and there were no OB-GYN sonologists (the sub-specialty came so much later). So off she went to the general sonologist, and true enough, there was no pregnancy. Her intense desire to have a baby somehow triggered all the pregnancy signs and symptoms: no menses, nausea and vomiting, easy fatigability, abdominal enlargement. 

‘Phantom pregnancy’
 

The medical term for this condition is “pseudocyesis,” which literally means, a “false pregnancy.” Some call it “hysterical pregnancy,” or “phantom pregnancy.” 

 

Pseudocyesis is not a modern phenomenon. As early as 300 B.C., Hippocrates, the father of medicine, reported 12 such cases during his time. Even the English queen, Mary of Tudor, exhibited it (and her vicious temperament was probably because of this), as she was under duress to produce an heir.  

 

The condition is usually brought about by the strong and intense wish of the woman for a child. It triggers neuro-chemical changes in the brain that somehow makes her stop menstruating, gain weight, feel nausea and even vomit, feel tired easily, and in extreme cases, detect fetal movements. Indeed, she mimics all the signs and symptoms of pregnancy, and deludes herself that she is with child.

Psychologically, the woman can even subconsciously “pressure” the brain centers to trigger chemical reactions that can produce prolactin, which causes milk production in the breasts! The mind indeed, can trick us into believing what we want to believe. 

 

Many times, because of pressure from the male partner, the in-laws, grandparents, and even well-meaning friends, many women feel desperate and helpless when they could not conceive. The body then fools itself, and the woman starts to feel that she is pregnant. Intestinal gas passing through the bowels could be misinterpreted as the baby’s movements.

Some patients even get emotional and blame the doctor for telling them the truth—they simply want to cling to this notion rather than face painful reality.

 

Just last week, a patient went to the clinic in her “sixth month,” because she said the baby seemed to have stopped kicking. It was her first baby, and I became suspicious when she told me she has not had any prenatal check-ups before. 

 

She looked chubby, and was wearing a loose maternity dress with an empire cut; at one glance she indeed looked pregnant. But on examination no baby was detected, and although her cervix was soft (for indeed, the extreme desire can also trigger hormones in the brain to cause cervical softening, which is one of the early changes during pregnancy), the uterus was small. She looked shocked when I told her the news, and she insisted on a pelvic ultrasound to prove me wrong.

Sadly, she was disappointed when she saw the results. I could only commiserate with her, and advised her to see an infertility specialist. It wouldn’t hurt to consult a psychiatrist too, I told her, for more support. 

 

For young doctors practicing in the city nowadays, all the ancillary procedures like a serum LH (pregnancy test using blood serum), and a sensitive ultrasound machine plus an alert and well-trained sonologist are always within one’s reach.

The difficulty lies when one practices in remote areas where these procedures are not available, or when there is a lack of properly-trained OB sonologists. The good doctor then needs to rely on her clinical acumen, her keen observation (and a lot of intuition and gut feeling) during history taking; and of course, on the pelvic examination results. —KG, GMA News

Dr. Alice M. Sun-Cua is an author and practicing obstetrician-gynecologist at the San Juan de Dios Hospital in Pasay City.