CHENNAI: A girl, younger than 17 years of age, found herself in the hospital for severe abdominal pain. The family suspected appendicitis, but the truth was far more shocking. Unknown to the girl and her mother who had accompanied her, she was in labour. Called cryptic pregnancy or stealth pregnancy, this phenomenon, while rare, is not unheard of. “It refers to when women are not aware that they are pregnant. They might have no symptoms and are diagnosed very late at 5-6 months, sometimes (though rarely) finding out while they are in labour,” explains Dr Amudha Hari, consultant - gynaecologist, Motherhood Hospital, who had tended to the teenager. Along with Dr Premalatha Balachandran, consultant - obstetrician and gynaecologist, she explains the phenomenon, its causes and implications.
What are the reasons for a cryptic pregnancy?
PB: This is more found in women who have irregular periods. For example, some only get their periods once in three or six months so they often think of it as a missed period. Also, It is not necessary that all women have symptoms of pregnancy such as nausea and vomiting. There are some who don’t, so when they come in for a regular check-up or because they haven’t had periods for about six months, they find out then that they are actually pregnant. Furthermore, perhaps a urine test may miss the pregnancy and sometimes, breastfeeding women (since they don’t have their periods during the period) think they won’t conceive.
AH: Some women also may have periods while they are pregnant, but this is a very rare occurrence. Also, with perimenopausal women, they stop menstruation and may have irregular spotting, so they do not expect it. I once knew a doctor who was going through perimenopause and realised something was different when she hadn’t had her period for six months. When she checked, she found out that she was pregnant.
How common is this in India? Are people aware?
PB: While the statistics say something like one in 450-500, it is an uncommon occurrence. Many are not aware that they can be pregnant without the symptoms so they are often very surprised. Some don’t even feel the movement (of the foetus), mistaking it to be a bowel movement.
AH: Very less people are aware of this. Of course, some women have irregular periods, but if suddenly they find anything in their body that might be a symptom they have to look into it, especially if they are sexually active and young.
What are some of the ways to prevent or medically evaluate a cryptic pregnancy?
PB: Whenever women miss their periods, even if they have them irregularly, it is best to ensure you have them at least every two months. One could take a tablet for the same. It is not good for the health of the person generally to go on for a long time without menstruation. If someone has missed their period for more than two months, it is best to get a test or in any case, withdrawal bleed every two months. If you take a tablet and still don’t bleed, one should go for a scan to check for the pregnancy.
AH: If you are on medicines/antibiotics, the urine test may not be able to detect the pregnancy and there are also cases of two uteruses, where one may have a small pregnancy and the other is empty so they could be misled. So, if there is any suspicion at all, the best thing would be an ultrasound.
Have you ever witnessed a cryptic pregnancy, how do the women react to the same? Could you speak of the social implications of the same?
PB: There are some who are breastfeeding and already have a small child and are suddenly pregnant again, so they are sometimes upset. But at the same time, people in the common reproductive age often take the news happily and go on with the pregnancy. Then there are some who have difficulty in conceiving and lose hope and are found to be pregnant, so they are very happy. Sometimes, those around the perimenopausal age don’t want to tell anyone. So, it really depends.
What are the options for these women available at the point of realisation?
PB: If the pregnancy is detected within 12 weeks, the woman can go for a termination, if wanted, under the Medical Termination of Pregnancy law. But, if it is post three months, one cannot do so without any problem in the pregnancy and so, unfortunately, they are stuck. If one does not want a baby, early detection is their best bet.