Pseudocyesis

The patient was admitted to the gynaecologic al ward at Dundee Royal Infirmary. She gavc a name of " Margaret Wa rd " and an age of 29 years . She had collapsed at Dundee railway station complaining of abdominal pain and had been transferred to the Casualty Department of Dundee Ro yal Infirmary. There she gave a history of 20 weeks' amenorrhoea since her last menstrual period on 29 September 1971. She complained of bleeding vaginally for the previous 3 days. While on an Aberdeen to Edinburgh train she had felt her " waters go" and she had flooded the seat before staggering from the tr ain at Dundee with severe abdominal pain "which was coming and going like labour pains". In view of the above history th e patient was admitted to the gynaecological ward as a threatened abortion. The above h istory was then repeated to the admitting hou se surgeon. who also Iearned that the patient was married to a fifth year medical student in Aberdeen. Her general pract iti oner was apparentl y aware of her threatening to miscarry and had ar ra nged for a distr ict nurse to collie in and give her regular in jections. She ga ve a history of a Caesarean section in Abe rdeen in 1966. (A " classic Caesar ean section because of a tr ans verse lie . the baby was unfortunatel y still born "). She also gave a history of a repeat classic Caesarean section in Kentucky. USA. in 1969. Again. the bab y was still born. When the houseman came to examine her abdomen he was presented with the follow ing (Fig. I). The scars arc explained as cholecystectomy, appendicectomy. renal b iop sy, gastric operation, and two Caesarean sect ion s. On palpation the patient appeared to have a 20-weeksize uterine mass arising out of the pelvi s. Speculum examination showed a multiparous os whi ch was closed. There was no blood, d ischarge or liquor seen in the vagina. The duty registrar was asked to see the patient. Her story was sligh t ly varied when told to him. She now reported that she was th e wife of a general practitioner in Aberdeen who would be unavailable because he was on call that weekend. When th e regist rar exam ined her abdom en he thought he could feci a uterine mass bill on bimanual examination he queried a small non pregnant, anteverted uterus. A gravindex pregnancy test was negative. No fetal heart was heard using a Sonicaid. The patient was then recognized (Fig . 2) as a well known case of pseudocyesis. This unfortunate girl had encephalitis when she was 4 years old . This left her with a psychotic nature; she is a pathological liar with certain fixations. These fixations are essentially: (I) pregnancy; (2) marital involvement with medical practitioners; and (3) safety pin swallowing. For many years the patient had been admitted to hospitals in the Sheffield area as a th reatened miscarriage. She had become practised in the art of abdominal distension or ret aining urine in the bladder to produce a pelvic swelling of th e appropriate gestation. Continual breast manipulation had produced in her active breasts with secretion from the nipples. Following an admission to hospital with pseudocyesis she then usually had a fixation on the houseman who had admitted her and began to pester him day and night through the switchboard and ward staff " looking for Dr . " She was his fiancee". Eventually the inevitable happened and she became pregnant. This baby was adopted by her parents and brought up as her "brother ". About this time she started a third fixation . This was swallowing safety pins, usually closed but unfortunately often op en . She usually did this " when she was fright. ened". This had necessitated 6 laparotomies for the removal of the open safety pins from various points in her small bowel (Tipton. 1972). Following numerous psychiatric referrals, the patient was sterilized. From 1967 she had appa rently caused little trouble with her admissions to hospital with pseudocyesis or pin swallow. ing. Howe ver, with her father recently d ying and her mother being admitted to hospital, she has slipped back into her old ways. Once recognized , the patient's abdomen was x-rayed and Fig. 3 shows the inev it able open safety pin lying in her small bowel. The patient was then transferred to the surgical ward "on take" for observation . Needless to say. she discharged herself aga inst med ical ad vice the next day.