What is a cryptic pregnancy?

Motherhood is reckoned as a blessing for a woman. The joy of being pregnant is reflected in body transitions like hormonal changes, weight gain, morning sickness, creation of menstruation, and a visible baby bump by the first trimester. But, some women are subjected to a condition of concealed or stealth pregnancy. The state is known as Cryptic Pregnancy. While it is common that the early signs of pregnancy go overlooked, when the symptoms remain unaware of their condition throughout the gestation period, it becomes a matter of concern. 

In Cryptic Pregnancy, the woman is likely to go in labor without prior knowledge of her pregnancy. Such cases of denied pregnancy throughout the incubation period pose substantial health risks to both mother and the fetus like poor nutrition, inadequate care, fetal mishandling, stillbirth, and neonatal deaths. Various studies across different countries suggest that the incidence of Cryptic Pregnancy is quite less. The rate of awareness up to the 20th week of pregnancy in Germany is 1 in 475 women. In Austria, it is 1 in 400, and in America, it is only 1 in 516 cases of childbirth. (1,2,3)

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Cryptic pregnancy causes

Causes or reasons behind the development of cryptic pregnancy

The main reason for the occurrence of Cryptic Pregnancy remains untraced. In women with mental illness or psychotic issues, the cause can be attributed to their denial of acceptance of their pregnancy. But, the justification for the condition in women with sound mental health is still unknown. One of the main reasons for the Cryptic Pregnancy is hereditary or if the condition runs in the family pedigree. Other reasons Cryptic Pregnancy are cited are hormonal imbalance in Poly-Cystic Ovarian Syndrome (PCOS), Perimenopause, Excessive stress, and a meager percentage of body fat. (1,4)

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Cryptic pregnancy symptoms

Cryptic pregnancy characteristics

There are some characteristics of Cryptic Pregnancy that leads to denial of the conceived fetus. A few of the traits are as follows: 

Pseudo menstrual bleeding and lack of nausea: There are various instances when pseudo menstrual bleeding has been reported in women with Cryptic Pregnancy. In such women, the uterus lining continues to shed throughout the pregnancy. Some patients experience irregular menstruation or spotting and thus ought to overlook their pregnant condition. Women with age on the higher side of 40, generally confuse it with menopause. Systemic scrutiny of women with Cryptic Pregnancy revealed that only 26% of them suffered from nausea. Thus, pseudo periods and absence of nausea is a significant facet of Cryptic Pregnancy.

Minimal abdominal swelling: The most eye-catching part of pregnancy is a noticeable baby bump that develops during the gestation period. But, in women with Cryptic Pregnancy, the abdominal swelling is either absent or very less. The episodes of natural shedding prevent the proper formation of the placenta, which in turn restricts the secretion of Human Chorionic Gonadotropin. The lack of HCG impedes the development and growth of the fetus. The slow growth leads to reduced abdominal swelling, and the pregnancy can remain hidden until delivery. The survey reports state that 56% of the Cryptic Pregnancy women reported nonexistent or scarce weight gain. 

Low birth weight and premature delivery: Low birth weight is a crucial implication of Cryptic Pregnancy. Due to the concealed state of gestation, pregnant ladies tend to avoid their health. They do not look after the fetus's health, and the hormonal imbalance also contributed to the incomplete development of the baby. All these factors were responsible for the extended gestation period as well as the premature birth of the baby. The survey reports illustrate that around 13% of preterm births were reported in Austria, while 18.5% of premature delivery from Germany was in Cryptic Pregnancy. 

The risk to neonate and fetus: While there is no evident record of risk of Cryptic Pregnancy on neonates and fetuses, but there are various instances when the rate of intrauterine fetal death was lofty in such patients. The prominent risk of neonatal death is due to the low birth weight and the increased rate of cesarean for delivery rather than normal delivery. The outcomes of investigations suggest that fetal and neonatal deaths prevail due to the shortage of proper antenatal care as mothers remain unaware of their condition for long periods. They might be involved in dangerous behaviors like unhealthy eating habits, vigorous exercises, drug abuse, smoking, and alcohol consumption.

Neonaticide, abuse, and neglecting of the fetus: When it comes to Cryptic Pregnancy, there are a few cases of neonaticide. Instead, major reported cases are of abortion. In the patient sample from Austria, there were fewer reports of emotional neglect, fetal abuse, and malnutrition of the baby or such instances of Cryptic Pregnancies might have bypassed the records. Women who were in denial of their pregnancy have committed neonaticide, but many were able to accept their baby. The women with Cryptic Pregnancy have taken good care of their newborns in most cases. (5)

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Cryptic Pregnancy Case Studies

Cryptic Pregnancy Case reports

There are a good number of cases of Cryptic Pregnancy all around the world. Some of them are cited below: 

● A 35-year-old lady with four children was admitted to the Emergency Department of California after complaining about prolonged abdominal pain. The pain was accompanied by episodes of nausea, vomiting, and diarrhea. While in the ED, the patient reports extreme pain, and after evaluation, it becomes evident that she is in labor due to Cryptic Pregnancy. But, she denies being pregnant. After proper evaluation, the medics perform an episiotomy to deliver a baby. But the expulsion of the f placenta is extended. 

● Another instance of a safe Cryptic Pregnancy was reported in Springfield. A woman complained of abdominal pain, stating a sandwich eaten at a store as the primary cause of anxiety. But investigation revealed that she was suffering from nausea and diarrhea, and the date of the last menstrual cycle was also uncertain. When she was admitted, the pain increased severely, and she was declared to be in labor. Later she delivered a healthy baby girl normally. As she was unaware of her pregnancy throughout the gestation, it was a case of Cryptic Pregnancy. (6)

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Summary

Cryptic pregnancy is a surprisingly common medical condition where women remain unaware of her pregnant state. The situation is likely to pose a potential threat to both the fetus and mother, but timely detection and proper delivery of the baby can save both the lives. 

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References

1. Bushaala, N. M. (2018). Cryptic pregnancy.

2. Finnegan, P., McKinstry, E., & Robinson, G. E. (1982). Denial of pregnancy and childbirth. The Canadian Journal of Psychiatry, 27(8), 672-674.

3. Stammers, K., & Long, N. (2014). Not your average birth: considering the possibility of denied or concealed pregnancy. Case Reports, 2014, bcr2014204800.

4. Cheyne, H. (2016). How women can go the full nine months without knowing they're pregnant. The Conversation.

5. Del Giudice, M. (2007). The evolutionary biology of cryptic pregnancy: A re-appraisal of the "denied pregnancy" phenomenon. Medical hypotheses, 68(2), 250-258.

6. Hulse, R. S., Ferrell, H., & Gurney, D. (2016). Cryptic Pregnancies in the Emergency Department. Journal of Emergency Nursing, 42(3), 284-286.

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