False pregnancy


False pregnancy is the appearance of clinical or subclinical signs and symptoms associated with pregnancy although the woman is not actually pregnant. This condition is extremely rare in the United States because of the frequent use of ultrasounds and imaging, but in third world countries like Africa and India, the incidence is significantly higher.This condition can be caused by trauma or a chemical imbalance. Events that can lead to false pregnancy include miscarriages, infertility, loss of a child, mental breakdown, or tumors. Some men can experience false pregnancy symptoms, called Couvade syndrome or sympathetic pregnancy, and can occur when their significant other is pregnant and dealing with pregnancy symptoms.

Signs and symptoms

The symptoms of pseudocyesis are similar to the symptoms of true pregnancy and are often difficult to distinguish from one another. The ratio of false pregnancies to true pregnancies was found to be 1:25.
Signs of false pregnancy include:
Tests and physical examinations are required to confirm false pregnancies: a pelvic exam, urinalysis, and an ultrasound. A pelvic exam can show if conception has occurred, a urinalysis tests for hormones released in pregnancy, and ultrasound shows the presence of the fetus. Only an ultrasound can accurately distinguish between a false and true pregnancy.

Cause

There are various explanations, none of which is universally accepted because of the complex involvement of cortical, hypothalamic, endocrine, and psychogenic factors. Endocrine changes observed in pseudocyesis include an increase in dopamine levels, nervous system activity, or dysfunction in the central nervous system. Causes of pseudocyesis can also be due to physical or mental trauma including miscarriages, infertility, loss of a child, sexual abuse, or ovarian tumors.
Psychological factors are heavily linked to cases of false pregnancies. Signs and symptoms may arise in women who are experiencing grief after loss in their reproductive abilities, rejecting the idea of motherhood and pregnancy, or facing challenges in gender identity. Menopause can cause depression in many women that can lead to pseudocyesis.

Treatment

False pregnancy can be detected with ultrasound. In some instances, false pregnancy detection via ultrasound is not enough to treat an individual's physical and psychological symptoms, thereby requiring other interventions. These interventions are aimed at biological changes associated with hormones and neurotransmitters and psychological factors.
Among hormones and neurotransmitters, reduction in dopamine levels are implicated in
In some cases, however, the patient may be given medications for such symptoms as the cessation of menstruation. When some 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.

Epidemiology

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. As of 2007, 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 girls as young as 6 and women as old as 79. Nevertheless, women of reproductive age comprise the majority of pseudocyesis cases. About 80% of women who experience pseudocyesis are married.
Despite being considered rare, pseudocyesis occurs more commonly in developing countries. In Africa, it is reported to occur in 1 out of every 344 pregnancies. In Ghana, over five years, 486 women sought sonographies due to assumptions of pregnancy; 3 of those women received diagnoses of pseudocyesis. Similarly, in Nigeria, 242 women sought sonographies for gynecological concerns; 5 of them received diagnoses of pseudocyesis. In Sudan, over five years, 20 out of 3200 women seeking infertility treatment at a teaching hospital received diagnoses of pseudocyesis.
Cultural markers also play a role in pseudocyesis occurrence rates. Pseudocyesis is reported more frequently in countries that place heavy emphasis on fertility and childbearing; such pronatalist beliefs are often highly prominent in developing countries. For example, in sub-Saharan Africa, a woman is allowed to share her husband's property only if she bears children. Additionally, in these countries, infertile women often experience abuse, blame, and discrimination. For instance, in Nigeria, where at least 20% of the population experiences infertility, a 12-month cross-sectional study of 233 infertile women revealed that 41.6% of the women had suffered domestic violence due to infertility. Such societal factors enforce the importance of female fertility in these countries, thus possibly contributing to these areas' relatively high pseudocyesis rates.

History

The perception of false pregnancy, or pseudocyesis, has evolved over time. In the late 17th century, French obstetrician François Mauriceau believed that the enlarged abdomens of falsely pregnant patients were caused by bad air. Physicians slowly began to acknowledge other potential causes of pseudocyesis, including its origin in the mind and in the body. By 1877, a clinician named Underhill observed that physical symptoms can convince a woman of pregnancy, or a “disordered brain” can convince her that ordinary abdominal pains or bowel movements are instead fetal movements. The idea that pseudocyesis could result from a woman's perception of herself led to investigation into the role of emotions in cases of pseudocyesis. An investigator in the early 20th century observed that strong emotions can dry a woman's milk supply. The investigator went on to infer that the opposite was also true, and it was believed that strong emotions could also bring about its production in women who are not pregnant. Alternatively, some physicians questioned the legitimacy of pseudocyesis as a condition. For instance, French obstetrician Charles Pajot stated in the 19th century, “there are no false pregnancies, only false diagnoses.”
Pseudocyesis has long fooled both women and their physicians. But physicians were expected to notice minute differences in cases of pseudocyesis that would indicate the absence of a fetus. Although the symptoms overlap, pregnancy symptoms in cases of pseudocyesis do not present as intensely. The abdomen becomes enlarged in both conditions, but in cases of pseudocyesis, the woman's navel does not turn outward. Women experiencing false pregnancies also tend to report uncharacteristically vigorous fetal movements for their supposed gestational state.
Despite the availability of modern ultrasound technology, women with false pregnancies are still mistaken for women in labor. In the mid-1960s, a young physician, John Radebaugh, responded to a woman who appeared to be in labor. She was not properly examined because delivery appeared imminent. The woman's water broke on Radebaugh, drenching him. But she had a false pregnancy, and the expelled liquid was urine. In 2010, a woman in the United States who was suspected of being in labor was given a C-section only to discover there was no fetus.

Famous Cases

, also known as "Bloody Mary," had a false pregnancy. After coming to terms with it, she reportedly believed that God had not made her pregnant because she had not sufficiently punished heretics.
Anna O, Sigmund Freud's most famous patient, experienced false pregnancy in the context of preexisting mental health problems. After being diagnosed with hysteria, she believed she was pregnant by Josef Breuer, her therapist. She even believed she was in labor as she was trying to have another session with Breuer.