PSEUDOCYESIS - FALSE PREGNANCY

............... False pregnancy, phantom pregnancy, or hysterical pregnancy—commonly called pseudocyesis in humans and pseudopregnancy in other mammals—is the appearance of clinical or subclinical signs and symptoms associated with pregnancy when the organism is not actually pregnant. I have encountered this condition more than once and I found it very interesting. I had a case of a woman who came in for regular maternal health clinic. She looked around 8 months pregnant and she was looking forward to the birth of her child. She was very faithful in ANC clinics and had already started shopping for baby clothes. She had however come with a note from another clinician who was surprised with the 'pregnancy' because Pregnancy Determination Test was negative severally. He had referred her for further follow-up and ultrasound. I examined her and she looked pregnant. She had missed her monthly menstrual periods by 8 months, the abdomen was markedly distended( almost a term pregnancy), her breasts were discharging milk and she had Linear nigra ( the prominent black line down from the umbilicus seen in pregnancy), the 'baby' was also kicking and she excitedly grab my hand and place it on the abdomen to feel the movements. Her face was puffy like that of a pregnant woman. There were however several catches. Though the abdomen was distended, I couldn't feel the hard gravid uterus. There was no palpable fundus. The 'kicks' were actually peristaltic movements(bowel movements) confirmed on  auscultation with my stethoscope. I talked to her further and I realized that she was  desperate for a baby. I tried to counsel her on the possibility that there was no pregnancy but she reminded me that she even had morning sickness in the first trimester and the abdomen had been increasing in size slowly over the months. She believed that the previous laboratory that did her pregnancy test had fake strips.  I decided to send her for a repeat pregnancy test and an 'obstetric' ultrasound. The results came out promptly. Pregnancy test was negative and the ultrasound was a normal one with a normal non-gravid uterus. There was no baby. An abdominal ultrasound was also done just to make sure that it wasn't an abdominal pregnancy and it was also a normal scan. I took to the task of counseling her further and telling her about a medical condition called PSEUDOCYESIS. It's a false pregnancy caused by the effect of stress on the hypothalamo-pituitary-adrenal axis causing hormonal changes that stimulate pregnancy-like changes in the body. She was so stressed and desperate for a child and the brain triggered a pregnancy-mode in the body. We had a similar case of a woman who came in labour pains for a 'term pregnancy' but the midwife nurse was surprised that the cervix was  closed despite the woman having very strong visible contractions for many hours. She also wasn't so sure about the uterus fundus because she couldn't feel it well but certainly there were contractions. From the history we were prepared for the worst and probably a caesarean section. A quick but thorough routine ultrasound was done and there was no pregnancy even though the contractions were real. The woman ofcourse cursed and blamed it on witchcraft by her enemies who had taken her baby from the womb in the last minute to delivery. But there was no witchcraft, the diagnosis was PSEUDOCYESIS in a woman so desperate for a baby. Pregnancy test was negative.   Back to my first patient, I started treatment for her and she accepted her condition albeit half heartedly. I prescribed to her antidepressants for the psychological problem and bromocriptine to arrest the milk production. She has been faithful in her monthly follow-ups for the last 6 months and slowly we have been successful in 'reversing' the pregnancy. The abdomen has markedly decreased in size, her face is no longer puffy, her monthly periods are back and the milk production has stopped . The baby 'kicks' have also disappeared.  I hope from this post on PSEUDOCYESIS we get to acknowledge the power of the mind.  If the mind is so powerful as to simulate a false pregnancy then imagine what more it can do. This reminds me of a quote that says;  'The greatest force is derived from the power of thought. The finer the element, the more powerful it is. The silent power of thought influences people even at a distance, because mind is one as well as many. The universe is a cobweb; minds are spiders. - Swami Vivekananda' I hope you have a lovely week ahead and get to utilize the power of the mind to achieve great things in life. 

ABORTIONS AMONG MARRIED WOMEN

ABORTIONS AMONG MARRIED WOMEN This past week, I witnessed a rising number of abortions among married women. I really couldn't understand what would make a married woman want to terminate a child born within the family unit. If it were a teenager or a single woman, or even a widow, I would understand.     Kenyan statistics indicate that there are about 310,000 abortions every year in Kenya. 21,000 women are admitted each year due to abortion related complications from having unsafe abortions – usually done in backstreet clinics. 2,600 of these eventually die. Of the women admitted, 12% were older than 34, 40% were between 25 and 34 while 16% were teenagers.  Clearly the more mature women above age 25 take the lead.  I usually break pregnancy news with a smile and a congratulatory note but this week I was faced with rude answers and tears among some of the women. Many cried uncontrollably and I had to probe further and ask what had triggered the sadness. They were after all married and with other children. They all complained of the rising cost of living and lack of happiness in the family. Some stated that their husbands were less concerned about taking care of the children and that the women had to hustle singlehandedly to raise the children.  A few begged for abortions but I was very frank with them that it's a crime in the Kenyan law and a big sin in the eyes of the Lord. I did counsel them and told them they should take it as a blessing and reminded them that there are many women who are desperate to have children. One lady told me that God should have taken what was in her womb and given it to a more deserving desperate woman.   We have had cases of women who come in with ruptured uteruses or sepsis only for us to find big rough sticks, metal rods, wooden objects etc that have gone through the uterus into the abdominal cavity. All these are usually among married women in their 30s and 40s. The teenagers are usually surprisingly less 'radical' in their methods of terminating pregnancies. I must say that older women have guts.  Most of the time when I get married women coming in with pre-term labour or abnormal bleeding in pregnancy, i'm usually very tough and demand to know what they used to illegally trigger labour. It's mostly strong concoctions taken or objects inserted into the uterus.  So what is causing so many abortions in family units? Are our husbands too busy at work to remember the family, is it alcohol and substance abuse, is it because of extramarital affairs and they end up neglecting their wives and children?  Or are women increasingly wanting an emotional and psychological readiness before carrying on with a pregnancy?   Those from the urban areas say it is more of a lifestyle choice than anything else because they would, for example, rather pursue a career than have a child. Increased westernization of the country has made traditionally large families to be frowned upon by many modern women in general. The average child per woman in Kenya in the 70s was eight, while today, the figure is just under three. How do we prevent this vice in marriage?  In my opinion, every woman after delivery should be advised on the different contraceptives before discharge from the maternity. The husbands should actively participate in the choice and use of contraceptives. Women nearing 40s can be advised on more permanent methods of family planning like tubal-ligation (Can our men agree to have vasectomies????). Men should be more dedicated in caring for their families. A law should be passed to arrest and charge any woman who attempted abortion; but this would mean that such women would be scared to come to hospitals and would die at home from life threatening complications. It's a very controversial topic. It's something that needs to be discussed and analyzed more deeply.  I will end my post today with a reminder of the Kenyan laws on abortion.  Abortion Laws in Kenya Article 26 in the new constitution was the bone of contention between the pro-life and pro-choice groups in the build up to the referendum. Article 26 of the Constitution contains 4 clauses on the rights to life which state that: 1). Every person has the right to life; 2). The life of a person begins at conception; 3). A person shall not be deprived of life intentionally, except to the extent authorized by this constitution or other written law; 4). Abortion is not permitted unless, in the opinion of a trained health professional, there is a need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law Have a happy valentines week!!!