Serial factitious disorder and Munchausen by proxy in pregnancy

Area of Science:

• Obstetrics and Gynecology
• Psychiatry
• Medical Ethics

Background:

• Factitious disorder, including Munchausen syndrome, is rarely documented in pregnant patients.
• This condition can lead to severe maternal and fetal complications.
• Early identification and intervention are crucial for managing such cases.

Observation:

• A 44-year-old woman with a history of factitious disorder self-induced labor in five pregnancies over 20 years.
• Methods included amniotic sac rupture, cervical manipulation, and self-administration of prostaglandins.
• She sought medical attention through deceptive behaviors, including fabricating heavy menstrual bleeding leading to an unnecessary hysterectomy.

Findings:

• Preterm deliveries resulted in one fetal demise and neonatal intensive care for two infants.
• One child developed cerebral palsy, raising concerns of Munchausen by proxy.
• The patient's factitious behavior remained undetected by her healthcare providers for two decades.

Implications:

• Highlights the diagnostic challenges of factitious disorder in pregnancy.
• Underscores the potential for severe harm to both mother and child.
• Emphasizes the need for increased awareness and specialized diagnostic approaches in obstetrics and gynecology.
• Raises ethical considerations regarding patient deception and potential child endangerment.