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Unexpected delivery: cryptic pregnancy.

Louise Dunphy1, Stephanie Boyle2, Lynda Coughlin2

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Summary
This summary is machine-generated.

Cryptic pregnancy, where individuals are unaware of their pregnancy until late stages or labor, can lead to adverse outcomes due to lack of antenatal care. This case highlights the importance of considering pregnancy in women with unexplained symptoms, regardless of risk factors.

Keywords:
Emergency medicineObstetrics and gynaecologyPregnancy

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Area of Science:

  • Obstetrics and Gynecology
  • Reproductive Health
  • Clinical Case Study

Background:

  • Cryptic pregnancy, or pregnancy denial, is a rare condition where an individual remains unaware of their pregnancy until late gestation or labor.
  • Historically termed 'concealed pregnancy,' it can occur with or without psychiatric manifestations.
  • Risk factors include young age, low education, precarious employment, and being single.

Observation:

  • A nulliparous woman with polycystic ovary syndrome (PCOS) and a high BMI (51.6 kg/m²) presented to the Emergency Department in labor with abdominal pain and hypertension.
  • She was unaware of her pregnancy, despite experiencing symptoms like weight gain, lethargy, carpal tunnel syndrome, and acid reflux over six months.
  • A pregnancy test was not offered despite regular sexual activity and lack of contraception.

Findings:

  • The patient was diagnosed with pre-eclampsia and delivered a live neonate via emergency cesarean section.
  • The neonate's growth was within the normal range (45.2nd centile).
  • This case underscores the potential for adverse maternal and fetal outcomes due to lack of antenatal care in cryptic pregnancies.

Implications:

  • Healthcare providers should maintain a high index of suspicion for cryptic pregnancy in women of reproductive age presenting with recurrent, unexplained symptoms.
  • Pregnancy testing should be considered irrespective of BMI, PCOS history, or perceived infertility.
  • Primary care and emergency physicians must be aware of cryptic pregnancy to ensure timely diagnosis and appropriate management, improving maternal and fetal outcomes.