pregnancy symptoms

History

Cases of pseudocyesis have been documented since antiquity. Hippocrates gives us the first written account around 300 B.C. when he recorded 12 different cases of women with the disorder. Mary Tudor (1516-1558), Queen of England, was perhaps the most famous of western historical examples, who believed on several occasions that she was pregnant, when she was in fact not. Some even attribute the violence that gave her the nickname "Bloody Mary" as a reaction to her disappointment on realising she was without child. Other medical historians believe that the queen's physicians mistook fibroid tumors in her uterus for a pregnancy.

Signs and symptoms

The symptoms of pseudocyesis are similar to the symptoms of true pregnancy and are often hard to distinguish from such natural signs as amenorrhoea, morning sickness, tender breasts, and weight gain may all be present. Many health care professionals can be deceived by the symptoms associated with pseudocyesis. Research shows that 18% of women with pseudocyesis were at one time diagnosed as pregnant by medical professionals.

The hallmark sign of pseudocyesis that is common to all cases is that the affected patient is convinced that she is pregnant. Abdominal distension is the most common physical symptom of pseudocyesis (60– 90%). The abdomen expands in the same manner as it does during pregnancy, so that the affected woman looks pregnant. This phenomenon is thought to be caused by buildup of gas, fat, feces, or urine. These symptoms often resolve under general anesthesia and the woman's abdomen returns to its normal size.

The second most common physical sign of pseudocyesis is menstrual irregularity (50–90%). Women are also reported to experience the sensation of fetal movements known as quickening, even though there is no fetus present (50%-75%).Other common signs and symptoms include: gastrointestinal symptoms, breast changes or secretions, labor pains, uterine enlargement, and softening of the cervix. One percent of women eventually experience false labor.

Causes

There are various explanations, none of which are universally accepted. Psychodynamic theories attribute the false pregnancy to emotional conflict. It is thought that an intense desire to become pregnant, or an intense fear of becoming pregnant, can create internal conflicts and changes in the endocrine system, which may explain some of the symptoms of pseudocyesis. Another theory concerns wish-fulfillment. It holds that if a women desires pregnancy badly enough she may interpret minor changes in her body as signs of pregnancy.

Biological mechanisms proposed include the effect of stress on the hypothalamo-pituitary-adrenal axis, constipation, weight gain and the movement of intestinal gas.

Demographics

The rate of pseudocyesis in the United States has declined significantly in the past century. In the 1940s there was one occurrence for approximately every 250 pregnancies. This rate has since dropped to between one and six occurrences for every 22,000 births. The average age of the affected woman is 33, though cases have been reported for women as young as 6-1/2 and as old as 79. More than two-thirds of women who experience pseudocyesis are married, and about one-third have been pregnant at least once. Women who have been victims of incest may be at greater risk for developing pseudocyesis.

Treatment

Because pseudocyesis is not known to have a direct underlying physical cause, there are no general recommendations regarding treatment with medications. In some cases, however, the patient may be given medications for such symptoms as the cessation of menstruation. Because most patients with pseudocyesis have underlying psychological problems, they should be referred to a psychotherapist for the treatment of these problems. It is important at the same time, however, for the treating professional not to minimize the reality of the patient's physical symptoms.

The treatment that has had the most success is demonstrating to the patient that she is not really pregnant by the use of ultrasound or other imaging techniques.

Alternative therapies

There have been reports of patients being cured of pseudocyesis by hypnosis, purgatives, massage, opioids, or after nine months of symptoms, by experiencing "hysterical childbirth," but there are few data available on the effectiveness of these or similar procedures.

External links

• Paul M. Paulman, Abdul Sadat. Pseudocyesis. Journal of Family Practice, May, 1990
• Early Pregnancy Symptoms and Test