RCOG World Congress 2025

Background: A concealed pregnancy is when a woman knows she is pregnant but does not tell any health professional; or when she tells another professional but conceals the fact that she is not accessing antenatal care; or when a pregnant woman tells another person or persons, and they conceal the fact from all health agencies

-- -- Denial of pregnancy is an important condition that is more common than expected with an incidence at 20 weeks gestation of approximately 1 in 475. The proportion of cases persisting until delivery is about 1 in 2500, a rate similar to that of eclampsia Denial of pregnancy poses adverse consequences including psychological distress, unassisted delivery and neonaticide

Patient Overview: 20-year-old female

•Presentation: Abdominal pain, distension, and per vaginal (PV) bleeding

• No significant past medical history

•: Lives alone

•Duration of Abdominal Pain: 1 week

•Previous Treatment: Oral antibiotics for presumed urinary tract infection (UTI) without improvement

•Menstrual History: Regular periods; on mini-pill contraception

•Pregnancy Awareness: Unclear; patient was vague about the possibility of being pregnant

•Family Presence: Accompanied by family but repeatedly asked them to step out during history taking

Vital Signs: pulse 140 otherwise stable

•Abdominal Examination: Massive distension, Two palpable masses and Offensive odor

•Pelvic Examination: Declined vaginal examination

•Pregnancy Test: Positive Blood Tests: check table

•Incident: Patient called for help, reporting something coming out of her vagina

•Examination: Baby’s head visible at the perineum

•Findings: Intrauterine death (IUD) of the fetus, Fetal head fluid-filled and stuck in the perineum due to shoulder dystocia Attempted vaginal delivery unsuccessful

•Decision: Proceed to theatre for delivery

•Patient Consent: Patient consented to the procedure but showed no interest in knowing about the baby or the situation

•in theatre

-Examination: Proper assessment completed

-Fetal Outcome: Macerated term intrauterine death (IUD)

-Delivery: Performed via posterior arm manoeuvre due to shoulder dystocia

-Umbilical cord was found detached from the placenta

-Placenta: Noted to have an offensive smell Sent for histological examination

-Postpartum Haemorrhage (PPH) due to uterine atony

-Management: Uterotonic medications administered Intrauterine balloon inserted

-Estimated Blood Loss (EBL): 1.8 liters

-Debriefing: Patient debriefed but showed no interest in the details Family Communication: Consent obtained to update her family

in ICU

- Patient admitted to ICU due to sepsis , AKI and stayed for 2 days

- Received 2 units of RBC

-I.V antibiotics

-Ballon and pack removed after 24 hours with no further bleeding

-Investigations improved please check the table

Discharge

-Patient remained in the ward for 2 days

-Switched to oral antibiotics

-Seen by Bereavement team

-Seen 8 weeks after discharge and she was feeling better and had a proper debrief

-Support given from the bereavement team , GP and her family

-Discussed option of contraception

-Discussed future pregnancies

-Follow up in 6 months arranged

blood results

This case presented significant challenges due to a concealed pregnancy complicated by a macerated intrauterine fetal death (IUD), sepsis, and acute kidney injury (AKI). Delivery was further complicated by shoulder dystocia, followed by a postpartum haemorrhage (PPH). In addition to the medical complexities, the emotional and social dimensions of the case added further difficulty. The patient initially wished to keep the situation from her family and requested that only a limited number of healthcare professionals be involved in her care

Concealed pregnancy is a complex, multidimensional and temporal process where a woman is aware of her pregnancy and copes by keeping it secret and hidden. Behaviours such as avoidance, hiding, using a daytime story, staying away and secrecy are key characteristics. Fear (of others or for others) is central to the process and an interaction with another antecedent e.g. context/culture or a perceived lack of support to mother her infant leads to concealing a pregnancy. It is a difficult and traumatic experience for the woman. Variations in the duration of concealed pregnancy exist and recurrence may feature in this process.

Understanding the concept of concealed pregnancy and its antecedents, attributes and consequences may assist in risk identification of women who conceal a pregnancy. This concept analysis has identified a need for further exploration of the coping styles and psychosocial processes involved in women concealing and revealing a pregnancy(2).

RCOG World Congress 2025

Concealed Pregnancy Near Term Complicated by Sepsis, PPH, AKI, and ICU Admission

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