THE FRAUD CALLED CRYPTIC PREGNANCY

The fraud called ‘cryptic pregnancy’ in certain countries fuels the baby factory business. The term ‘cryptic pregnancy’ is fraudulently used in certain countries to described false pregnancy also called pseudocyesis. Women mostly infertile, who are desirous of children are deceived into subscribing to this scam. These women are often introduced by other beneficiary of the act by their testimony. They are told they will be assisted to get pregnant irrespective of their age without any modern assisted reproductive technology methods. These women are given some hormonal medications to cause some changes in their bodies.

Also, they are told the exact date of the delivery and the route of delivery which must be caesarean section. They are told not to consult with an obstetrician or get a pregnancy scan. Reason being that the pregnancy is cryptic and cannot be detected by pregnancy test nor ultrasound scan. While all these are ongoing, the fraudsters arrange for a baby from a baby factory to be delivered to their unsuspecting victim on the scheduled date of delivery. At the delivery, the woman is sedated while an incision is made on the abdomen and closed. The woman wakes up to the sight of a new born baby which she takes home as her own. 

WHAT REALLY IS CRYPTIC PREGNANCY?

Cryptic pregnancy or pregnancy denial also known as pregnancy with late detection is a covert pregnancy where the woman is not aware she is pregnant.  The usual pregnancy test will not detect pregnancy probably due to low or ineffective human chorionic gonadotropin (hCG). Also, scan cannot detect it due to its small nature; the growth of babies in cryptic pregnancies usually lags behind. Here, the symptoms of pregnancy (loss of menses, nausea, vomiting etc) are reduce and not always present.

Furthermore, the physical appearance is not usual as the tummy might be flat. Cryptic pregnancy appears to reduce the costs of pregnancy thus, favouring the mother at the expense of the baby. It is rare and occurs in 1 in 475 pregnancies at 20weeks of pregnancy according to a German study. Its might not be detected until about the 20^th week or during labour. Hence, the name pregnancy with late detection.

WHAT IS RESPONSIBLE FOR PREGNANCY SYMPTOMS AND SIGNS?

The changes to expect in pregnancy result from both hormonal and anatomical influences. The anatomical changes are under the influence of several hormones. Among these pregnancy hormones is the human gonadotropin hormone (hCG). This hormone is secreted by the placenta and it prevent the regression of the corpus luteum. The corpus luteum is responsible for the secretion of progesterone and oestrogen in the early pregnancy to prevent menstruation. While the oestrogen causes the lining of the womb to continue to grow and store nutrient for the developing baby, progesterone maintains quiescent of the womb.

The hCG hormone is secreted into the lining of the womb where it accumulates before its release into the blood stream and then urine. As early as the 20^th to 21^st day from the last menses, the β-hCG can be detected in the blood. From the 28^th day from the last menses, it can be detected in the urine by pregnancy test strips. It levels rises to a maximum at about the 10^th week of pregnancy and begins to fall from the 12^th week. The hCG is responsible for the nausea and vomiting in early pregnancy.

WHAT IS DIFFERENT IN CRYPTIC PREGNANCY?

A Rwandan proverb says, ‘pregnancy and fire cannot be kept secret’. Cryptic pregnancy however, begs to differ. It might just be evolutionary to increase maternal survival in pregnancy. Reduced hCG production and/or effectiveness is likely to be involved in the process. In cryptic pregnancy, the lining of the womb continues to shed (the woman might continue to spot blood) hindering the accumulation of hCG and it appearance in blood and urine. This is responsible for the negative pregnancy test. It could also result from failure to adjust from the interaction between the mother and baby due to some genetic reasons. It might be a coping mechanism in the relationship between the mother and baby in the stressful situation to increase her survival by decreasing her investment on the baby. Psychologically, the pregnancy might not be accepted by the woman. This can also result in late detection of the pregnancy.

WHAT SHOULD BE THE APPROPRIATE TERMINOLOGY?

In my opinion, I will prefer the term pregnancy denial or pregnancy with late detection. It is practically impossible in this modern obstetric practice that a pregnancy can go undetected till delivery. Ultrasound scan can detect a viable pregnancy as early as 6weeks from the first day of the last menses. The movement of the baby is usually felt around the 18^th to 20^th weeks of pregnancy. The question here is, why is this movement not felt by the woman with the cryptic pregnancy? Are these fetal movements confused for intestinal movement?

The possible explanation for this might be the psychological aspect of denying the pregnancy. Another explanation could be the deviation of the mind of the healthcare providers from pregnancy. The thought of pregnancy is not usually entertained in women who report regular menses. From accounts of some case reports of cryptic pregnancies, the womb was found to be gravid on abdominal examination. Therefore, it is imperative for the healthcare providers to screen for pregnancy using scan in women reporting pregnancy symptoms despite account of regular menses. A 20weeks pregnancy sitting in the womb should not be missed on scan.

RISK FACTORS OR CAUSES OF CRYPTIC PREGNANCY

It may be difficult to predict at risk women. Variant can be found in women with psychotic disorders. However, this condition occurs commonly in young, single, unmarried, non-psychotic women. Usually in situation where there is imbalance in the female hormones such as;

• Polycystic ovarian syndrome (PCOS)
• Perimenopausal women
• Women on birth control pills
• Women breastfeeding
• Women with low body mass index
• Extreme stress

COMPLICATIONS OF CRYPTIC PREGNANCY

These include;

• Psychological distress
• Birth before arrival to the delivery suite and it complications
• Preterm birth
• Babies that are small for their gestational age
• Death of the neonate.