The experience of a young British woman who unknowingly carried a pregnancy to term, delivering her baby while on vacation in Australia, has brought the phenomenon of “cryptic pregnancy” into sharper focus. The case, reported by several news outlets including The Sun and the New York Post, highlights the rare but real possibility of a pregnancy going undetected for an extended period, even until the onset of labor.
Hattie Shepherd, 21, was enjoying a trip to Australia with her boyfriend when she began experiencing abdominal pain. Initially attributing the discomfort to food poisoning or gastroenteritis, she took over-the-counter pain relievers. However, the pain intensified, eventually leading her to seek medical attention at Gold Coast University Hospital in Queensland. An ultrasound revealed the astonishing truth: she was in labor.
Both Shepherd and her partner were shocked by the diagnosis, as she had been using contraception and had no typical signs of pregnancy. Photos taken just two weeks prior to delivery show no visible abdominal distension, even at eight months gestation. After approximately ten hours of labor, she gave birth to a healthy baby girl, Isla-Grace Cheadle, weighing 2.9 kilograms (6.4 pounds).
Understanding Cryptic Pregnancy
Shepherd’s case is an example of what is known as a cryptic pregnancy – a pregnancy that remains undiagnosed by the woman until late in the gestation period, or even until labor begins. While the exact prevalence is difficult to determine, estimates suggest that approximately one in 475 pregnancies may be cryptic. Cases where the pregnancy remains completely unnoticed until labor or immediately before are rarer, occurring in approximately one in 2,500 pregnancies.
Several factors can contribute to a cryptic pregnancy. In Shepherd’s case, the placenta’s position played a significant role. The placenta had migrated towards the front of her abdomen, and the fetus positioned itself along her spine. This configuration concealed the growing baby, preventing the outward appearance of a typical pregnancy bump and minimizing the sensation of fetal movement.
Shepherd’s underlying medical condition, Graves’ disease (hyperthyroidism), may have masked some of the usual signs of pregnancy. Graves’ disease can cause symptoms like dizziness, fatigue, and weight loss, which could have been misinterpreted as unrelated to pregnancy. She noted that she had initially attributed weight gain to a conscious effort to improve her diet and exercise regimen.
Why Do Cryptic Pregnancies Occur?
The reasons behind cryptic pregnancies are complex and not fully understood. Factors that may contribute include:
- Irregular Menstrual Cycles: Women with irregular periods may not immediately recognize a missed period as a sign of pregnancy.
- Perimenopause: Women in the transition to menopause may experience irregular bleeding patterns that can be mistaken for normal variations.
- Polycystic Ovary Syndrome (PCOS): PCOS can cause irregular periods and hormonal imbalances, potentially masking pregnancy symptoms.
- Contraceptive Use: While not foolproof, using contraception can lead to a lower index of suspicion for pregnancy.
- Psychological Factors: In some cases, psychological factors, such as denial or a strong aversion to pregnancy, may contribute to a woman’s failure to recognize the signs.
- Placental and Fetal Positioning: As seen in Shepherd’s case, the position of the placenta and fetus can significantly impact the visibility and detectability of the pregnancy.
It’s important to note that home pregnancy tests rely on detecting the hormone human chorionic gonadotropin (hCG) in urine. In some cryptic pregnancies, hCG levels may be lower than detectable by standard home tests, particularly in the early stages. However, a blood test performed by a healthcare professional is generally more sensitive and can detect lower levels of hCG.
What Does This Mean for Healthcare?
Cases like Shepherd’s underscore the importance of considering pregnancy as a possible diagnosis, even in women who report using contraception or who deny the possibility of pregnancy, particularly when presenting with abdominal pain or other symptoms that could be related to pregnancy. While cryptic pregnancies are rare, awareness of the condition can help healthcare providers avoid diagnostic delays and ensure appropriate care for both mother, and baby.
The Vice article highlights similar cases, noting that some women discover their pregnancy only seven or eight months in, while others, like Shepherd, realize they are pregnant as labor begins. The BBC has also reported on this phenomenon, with one woman giving birth alone at a beauty parlor, unaware she was pregnant until labor started. BBC News
Further research is needed to better understand the underlying mechanisms of cryptic pregnancies and to identify women who may be at increased risk. In the meantime, healthcare providers should remain vigilant and consider pregnancy in the differential diagnosis of abdominal pain and other relevant symptoms, even in unexpected circumstances.
