MEDISAINS - VOL. 17 NO.

2 (2019) 47-49

Case Report

O lord… where is my fetus? : a case report of pseudocyesis

Linda Yanti
Midwifery Department, Health Science Faculty, Universitas Harapan Bangsa, Purwokerto, Jawa Tengah, Indonesia

ARTICLE INFORMATION AB S T R AC T

Introduction: Pseudocyesis is a condition in which a woman presents various

Received: Agustus 21, 2019 signs and symptoms of pregnancy such as menstruation, nausea, vomiting, en-
Revised: September 03, 2019 largement of the womb, weight gain, and other pregnancy symptoms. Further-
Available online: Oktober 01, 2019 more, urine test may notice false positive result.

Case presentation: It was illustrated with unusual case of pseudocyesis to a 44

year old woman reported fetal loss at the age of six months of pregnancy to a
KEYWORDS health worker in Lampung province.

Pseudocyesis, Pregnancy, False Pregnancy Conclusion: Pseudocyesis symptoms are just common pregnancy, but actually
it is a false pregnancy.

CORRESPONDENCE
Phone: +6285328111988
E-mail: lindayanti@uhb.ac.id

INTRODUCTION disorders and conflicts in the community. The study aimed

to identify the phenomenon of a fetal loss or pseudocyesis.
Pseudocyesis is a rare case in various part of the world,
there is limited medical literature discussing the topic.1 CASE PRESENTATION
Most of pseudocyesis cases occur in the age group of 20
to 44 years old. Pseudocyesis incidents in Europe and A 44-year-old woman approached to a midwife complain-
America was 1-6/22.000 births.2 80% of the cases were ing that her fetus in her womb was loss. From the results
discovered in developing countries such as India or Afrika of a negative HCG examination, the abdomen appeared
and its 50% suffered from psychosis.3 The number of flat, balottement palpation was negative, and no fetal heart
pseudocyesis reported in Afrika was 1 out of 344 pregnan- rate was heard.
cies. 4 During 5 years from 486 women with abdominal dis-
tention in Ghana stated that they were pregnant. Six months ago, the patient obtained a pregnancy test at
the same midwife and presented positive HCG results, en-
The majority of cases of pseudocyesis occur in women of larged abdomen, 3 month amenorrhea and estimated 12
reproductive age and 80% of sufferers occur in married weeks of pregnancy, G7 P3 A3 (G: Gravida; P: Partus; A:
women.3 In Indonesia, the prevalence data on pseudocy- Abortus). The patient also conducted an ultrasonography
esis is not well documented. The case of pseudocyesis in examination at a gynecologic obstetric specialist which
Indonesia is only a phenomenon which appears in the discovered that there was no womb enlargement, no am-
community. The phenomenon of Pseudocyesis is often as- niotic membrane, and no amniotic fluid, no fetus and no
sociated with mystical things, because the sudden fetal fetal heart rate. Based on the interview, the patient would
loss caused suspicion among neighbors or the community. have a fourth child but during pregnancy experienced a re-
Previous studies on pseudocyesis had been conducted curring miscarriage up to 3 times, after 6 abdominal stom-
but more onto biopsychosocial and mental aspects.3,5 ach suddenly deflated, the patient assumed that the fetus
was lost due to supernatural power.
Unmanaged pseudocyesis may lead to mental disorders
(delusional disorder) 6. Therefore, early diagnosis and
proper handling need to be investigated to reduce mental
https://doi.org/10.30595/medisains.v17i2.5249
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 LINDA YANTI / MEDISAINS - VOL. 17 NO. 2 (2019) 47-49

DISCUSSION Women stress due to a pregnancy desire will produce ser-

otonin hormone and suppress dopamine and norepineph-
Pseudocyesis or false pregnancy is a somatic disorder in rine hormones, thereby increasing sympathetic nerve ac-
which a woman experiences signs of pregnancy which can tivity.7 Increasing the serotonin hormone will cause consti-
be seen physically, even though the woman is not truly pation, weight gain by accumulation of fat and accumula-
pregnant.7,8 Pseudocyesis is a disease associated with tion of gas in the gastrointestinal, thus making the enlarge-
psychiatric problems which believes that someone is preg- ment stomach.22 It is unknown how an increase in the hu-
nant even though the person is not actually pregnant, it is man chorionic gonadotropin hormone which causes preg-
triggered due to the urge to get pregnant.9,10 nancy with pseudocyesis shows positive results. When the
patient experiences happy because of the pregnancy, the
Commonly, pseudocyesis occurs to women with low soci- hormone serotonin decreases and is replaced by the en-
oeconomic status, limited access to health care, and ex- dorphin hormone. Dopamine and norepinephrine are in-
perience stress triggered by their desire to get pregnant. creased, thus decreasing sympathetic nerve activity. This
Besides, husband and family pressures who expect off- hormone balance restores the work of various organs, so
spring often makes a woman become stressed and de- that the gas which had been collected in the gastro intes-
pressed which triggers the emergence of peudocyesis tinal tract is disappeared, so that the stomach will deflate
11,12. Polycystic ovary syndrome is also a factor. 7,8 again.

The most common factor to a woman who experiences A very valid examination to detect pseudocyesis is Ultra-
pseudocyesis is due to a very long desire for the presence sonography (USG). Ultrasonography examination can see
of a child. Women suffered from schizophrenia and re- its fetal parts, amniotic fluid, and fetal heart rate. 23,24 to a
ceived antipsychotic treatment are also at risk of pseudo- truly pregnant woman at around 6 weeks pregnancy, the
cyesis.3 results of the conception can be seen through an ultraso-
nography examination, meanwhile pseudocyesis pregnant
Pseudocyesis patients normally believe that they are preg- is certainly no results seen.24 Physical examinations such
nant, but then suddenly loss, so that it is assumed to be as palpation and percussion can also be performed. A
taken by a supernatural creature.11 Besides, some people woman who experiences pseudocyesis shows a chewy
say that the fetus in the stomach has moved to another and tight sensation and when a percussion is performed,
person or other body part such as back because of a a hypertympany will be heard because of a bulk of gas. 7,
8, 2, 25
magic from someone.1,2

Pseudocyesis often shows common signs and symptoms Patients identified with pseudocyesis should be immedi-
of pregnancy, namely no menstruation, nausea, vomiting, ately transferred to a hospital for further examination, one
enlargement of the stomach, weight gain, and other preg- of which is an ultrasonography examination. Collaboration
nancy symptoms, and sometimes even urine test results between gynecologist and psychiatrist will be useful in
can be false positive, but actually they are not really preg- overcoming the problem.3–5,26,27 Through a proper diagno-
nant, 13,14 in some cases, patients also stated that they felt sis from gynecology and psychiatrists, conflict in the com-
fetal movements 4,15. This make some patients believe that munity regarding to mystically lost of fetus will be avoided.
she is pregnant.16 These symptoms generally last for sev-
eral weeks or several months, may even last more than Pseudocyesis can also be prevented by avoiding stress
nine months.7 Common people or even health providers and depression and assistance for expectant mothers be-
sometimes find it difficult to distinguish between real preg- cause often these cases are based on depression 40% -
nancy or pseudocyesis.17–20 60% and lead to the risk of premature death. If it is not
managed properly, it will lead to mental disability which
According to some literature, psychological problems are contributes to 4.3% of all diseases worldwide. 3,28
the main cause to the emergence of peudocyesis. When a
woman expects to get pregnant, her body will emit signs CONCLUSIONS AND RECOMMENDATION
which resemble the original pregnancy such as an
enlarged abdomen, enlarged breasts, and even a Pseudocyesis is a condition when a person experience
sensation of fetal movements in the stomach. It is because signs of pregnant but it is not real pregnant. Pseudocyesis
the hypophyse gland responds to the belief in pregnancy, manifestations found are amenorrhea, enlargement of the
which causes the catecholaminergic pathway which abdomen, bigger hips and positive PP test which is quite
regulates hormone secretion in the anterior pituitary to rare. Collaboration between gynecology and psychiatrist is
function properly resulting in hormonal imbalance. The necessary in order to get further treatment.
brain then produces the hormones estrogen and prolactin
which cause nausea, vomiting and enlargement in the
breasts.21

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