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.