Article Text

PDF
G293(P) Management of a concealed pregnancy
  1. F Finlay1,
  2. A Baverstock2,
  3. H Marcer1
  1. 1Child Health Department, Sirona Care and Health, Bath, UK
  2. 2Paediatrics, Musgrove Park Hospital, Taunton, UK

Abstract

Introduction A 23 year old lady and her newborn baby presented following a concealed pregnancy, An ambulance was called but unfortunately the baby subsequently died following severe hypoxic ischaemic encephalopathy secondary to a complicated home delivery. ‘Rapid Response Procedures’ were set in motion.

Aims This case presented interesting and challenging dilemmas. Questions we asked included: How common is a concealed pregnancy? What are the characteristics of women who have a concealed pregnancy? What are the risks/outcomes for the mother and the baby? What is the appropriate response when a concealed or denied pregnancy is suspected? The aim of this presentation is to answer these questions and suggest good practise guidelines.

Methods A literature research

Results How common

Thynne (Galway) – concealed pregnancy in 1 in 148 births

Nirmal (South Glamorgan) 1 in 2,500 births

Wessel (Berlin) denial of pregnancy 1 in 475 at 20 weeks gestation, 1 in 2455 at the point of delivery

Characteristcs

A heterogenous condition associated with different psychological features (Seigneurie).

External stresses can contribute to denial of pregnancy in otherwise well-adjusted women (Spielvogel)

Denial of fertility in these women – denial being regularly used as a defence mechanism in other aspects of their lives (Struye)

Those who denied their pregnancies tended to have a diagnosis of schizophrenia, have previously lost custody of children, and to anticipate separation from the baby (Miller).

Risks/outcomes

May have catastrophic consequences, including maternal and neonatal death (Murphy Tighe)

20% of infants in the concealed cohort had depressed Apgar scores at 1 min and 8% at 5 min (Nirmal).

Link between neonaticide and concealed pregnancy (Tursz, Vellut)

Response from health professionals

A referral should be made to Children’s Social Care about the unborn child if a concealed pregnancy is suspected. If the woman is under 18 then she should be considered is a child in need herself.

Conclusion A concealed pregnancy presents a significant challenge to professionals to safeguard the welfare and well-being of the child, both before and after birth, and the mother. An effective inter-agency approach is required.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.