Factitious disorder-by-proxy simulating fetal growth restriction

Although a variety of presentations have been described in the literature, the true prevalence of factitious disorder, also commonly known as Münchausen syndrome, and factitious disorder-by-proxy in pregnancy is unknown. The authors present a unique case in which intrauterine fetal growth restriction was simulated through fabrication of prenatal records.

A 30-year-old woman, gravida 6 para 3113, was transferred at 38 4/7 weeks of gestation for severe fetal growth restriction. The clinic listed in the patient-provided prenatal record was contacted to obtain original ultrasonographic reports for verification of gestational age; however, further investigation revealed the patient had never attended this clinic nor was the ostensible treating physician ever employed there. The initial prenatal record subsequently was determined to be entirely fabricated.

In this era of extensive technologic resources, health care providers should consider the possibility of factitious disorder when patient-provided medical record-derived information is inconsistent with the clinical presentation.