Obstetrics | Pseudocyesis

Hi everyone, welcome back to the MedBullets Step 2 and 3 podcast. In today's episode, we cover the topic of pseudosiesis found under the obstetrics section at MedBullets.com. Let's begin with a clinical snapshot. A 22-year-old woman presents to her primary care physician for prenatal care. The patient reports to having menstrual irregularities for the past four months. She says that she has been experiencing mild breast tenderness, increased urinary frequency,

and that she can feel the baby move. Beyond these symptoms, she denies any headache or galacteria. She takes a daily multivitamin and does not take any medications or home remedies. She feels relief for being pregnant due to the amount of pressure her family places on her.

emphasizing to her that becoming pregnant will ensure a happy marriage. On physical exam, there is increased pigmentation of the areola in a mildly enlarged abdomen without effacement of the umbilicus. Urine beta HCG is negative. Let's continue with an introduction to pseudosiesis. Clinically, it is defined as a rare somatic symptom disorder where a non-pregnant and non-psychotic woman thinks she is pregnant, and patients will also exhibit signs and symptoms of pregnancy.

In terms of the epidemiology, remember that the incidence is not known, and there is a decreased incidence in developed countries where there is a trend towards having a smaller family. Demographically, it affects females between 20 to 39 years of age. and risk factors include that it is perhaps more common in cultures that highly value childbearing, which may lead to psychological stressors. Another risk factor is misinterpretation of somatic stimuli. In terms of the pathophysiology,

It is unclear, but it may involve psychological mechanisms and neuroendocrine mechanisms. Moving on to the presentation, symptoms will include a belief that the patient is pregnant, menstrual irregularities, feeling that there is fetal movement, urinary frequency, and breast changes such as breast tenderness and nipple and areola pigmentation. On exam, one will most commonly note abdominal enlargement.

However, there will be no effacement of the umbilicus as would be seen in a normal pregnancy. In terms of the diagnostic criteria, the patient must not be pregnant or psychotic and exhibit signs and symptoms of pregnancy. In terms of the differential,

Make sure to think about pregnancy. Delusion of pregnancy, which is where patients have relatively absent symptoms suggestive of pregnancy and may have a psychotic disorder. Also think about medical conditions such as gestational trophoblastic disease. or high data-deformed mole, as well as prolactinoma and pelvic tumors. Also think about factitious disorder or malingering. In terms of treatment, conservative options include explaining the diagnosis in a therapeutic manner.

This is indicated as a key type of intervention in patients with pseudosiasis. Another option is counseling, which is indicated for treating patients with pseudosiasis. Complications related to pseudosiasis include that patients may become depressed if not appropriately managed. And lastly, with regards to prognosis, remember that the natural history of the disease is not well described. However, symptoms can last a few weeks.

nine months, or years. Patients may experience spontaneous recovery, and patients may have more than one episode of pseudosiesis. Positive prognostic variables include resolution of the psychological or interpersonal factors that may have contributed to the patient developing pseudosiesis. Now that we've discussed the major point relating to pseudosiesis, let's walk through a question to apply what we've learned and get a sense of how the topic might be tested.

For this question, consider the following clinical scenario. A 27 year old female presents for her first prenatal visit at an estimated gestational age of 16 weeks and 4 days by last menstrual period. She notes that she is presenting late to prenatal care due to significant anxiety about her pregnancy as she and her husband had struggled with infertility for several years prior to conceiving. The patient states that she has had nausea and vomiting for about two months.

tender and swollen breasts, and cravings for food she typically does not eat. She took a pregnancy test about 10 weeks ago and was too nervous to read the results immediately. After 24 hours, she saw that it was positive. The patient has a past medical history of bulimia nervosa but has not been symptomatic in two years. She also had an appendectomy at age 15 for appendicitis. She is a PhD student and her husband is a physician. At this visit...

The patient's temperature is 98.5 degrees Fahrenheit or 36.9 degrees Celsius. Pulse is 75 beats per minute. Blood pressure is 122 over 76 and respirations are 13 breaths per minute. The patient's affect is normal, and she is pleasant and excited about her pregnancy. Physical exam is notable for abdominal distention, but is otherwise unremarkable. An ultrasound is performed, which demonstrates normal transabdominal ultrasound findings.

and a urine human chorionic gonadotropin is negative in the office. Which of the following is the most likely diagnosis? And the answer choices are, choice one, pseudosiasis. Choice two, recent miscarriage. Choice three. Fiend Pregnancy, Choice 4 Kuvaad Syndrome, or Choice 5 Delusion of Pregnancy. The best answer to this question is...

Choice one, pseudosiasis. This patient presents with signs and symptoms of pregnancy, but a non-gravid uterus on ultrasound and a negative office pregnancy test. The most likely diagnosis is pseudosiasis. Pseudosiasis or false pregnancy most commonly presents with abdominal distension, breast tenderness, nausea, and other typical symptoms of pregnancy. Patients truly believe they are pregnant and may report positive pregnancy tests at home.

perhaps due to false positives from waiting too long before reading the result, but office testing is negative. Ultrasound will be normal and show the absence of a developing fetus. Let's also discuss why the other choices are incorrect. A recent miscarriage is unlikely as urine HCG testing often takes up to a month to become negative after pregnancy loss. Furthermore, the patient reports that her symptoms have been consistently present.

whereas a miscarriage would typically cause cessation of pregnancy symptoms. Choice 3. Fiend pregnancy is the intentional falsifying of symptoms for a clear external motive and is a subtype of factitious disorder or malingering. This patient does not express any desires for secondary gain and seems to truly believe that she is pregnant, which is more consistent with pseudosiasis. Choice four.

Cuvad syndrome refers to a quote-unquote sympathetic pregnancy in which a patient experiences pregnancy symptoms when someone close to her is pregnant. This does not apply to this patient. Choice 5. Delusion of pregnancy is a false and fixed belief about being pregnant despite factual evidence to suggest otherwise. Patients typically do not experience actual pregnancy symptoms and may have a history of psychotic disorders.

both of which are inconsistent with this patient's presentation. Finally, a bullet summary. Pseudosiasis is a somatic symptom disorder in which women believe they are pregnant and experience pregnancy symptoms without an actual pregnancy. That's all for this review about pseudosiasis. We hope that was helpful. This is the MedBullets Step 2 in 3 podcast, a daily audio review session for MedBullets, the free learning and collaboration community for medical student education.

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