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
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).
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.
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