While most women experience pregnancy signs and symptoms as early as the first month of pregnancy, some fail to realize they are pregnant until late in their pregnancy. It is estimated that 1 in every 475 women realize they are pregnant when the fetus is 20 weeks of gestation and 1 in 2,500 women get to know they are pregnant while in labor. This is a mysterious phenomenon called cryptic pregnancy.

 

What is cryptic Pregnancy? 

A cryptic pregnancy is one that cannot be detected by conventional pregnancy tests until delivery. It is a medically defined condition known as “denial of pregnancy” meaning you are pregnant, yet a hormone produced by the placenta called human chorionic gonadotrophic hormone (hCG), is too low to be detected in urine or blood test. As such, you lack the usual signs and symptoms of pregnancy like nausea and vomiting.

In some cases, a woman may experience pregnancy symptoms like morning sickness, vomiting, or even notice abdominal swelling but since the urine and blood test are negative, the symptoms are pinned to another cause.

 

Who is more likely to have a Cryptic Pregnancy?

Cryptic pregnancy is more likely to occur in the following circumstances:

• Women with the polycystic ovarian syndrome (PCOS)
• Premenopausal women
• Women using birth control pills and intrauterine devices
• Women who conceive soon after giving birth
• Women who are very obese

 

What makes Cryptic Pregnancy, Cryptic?

Cryptic pregnancy remains a mystery because:

• You may have normal periods all through the pregnancy because of incomplete shedding of the endometrial covering, however, the number of draining days might be less. Spotting and seeping because of implantation could be confused with an ordinary period.
• Pregnancy test from a urine and blood samples and ultrasound show negative, “no baby”
• Abdominal distension due to fetal growth is slower than in normal pregnancy because the baby is at the spine (back of the womb)
• The movements of the fetus in the uterus (womb) are confused with bloating and gas.

 

Why Do Urine and Blood Tests Show Negative Results?

The quantity of hCG hormone levels in the urine or blood determines pregnancy tests in a normal pregnancy. A low amount of hCG hormones are not detected by the conventional pregnancy test. This means pregnancy test may show a negative result in normal pregnancy if done too early. The test may also be negative if you don’t follow the instruction correctly.

Usually, the placenta produces hCG hormone which passes along the uterine lining. But in cryptic pregnancy, the lining of the uterus is shed periodically hence hCG fails to accumulate in the urine or blood samples to detectable levels.

 

Why Negative Ultrasound Result? 

Most cryptic pregnancy fails to be detected by ultrasound because of abnormalities of the uterus or abdominal region such as:

1. Retroversion of the uterus: The uterus is inclined towards the back making it difficult to visualize the fetus. 
2. Bicornuate uterus: Birth defect in which the uterus is heart-shaped with two horns. A wall completely or partially divides the uterus leading to cryptic pregnancy. The reproductive capacity of a woman may also be affected.
3. Abnormal scar tissue: This may occur as a result of abdominal surgery or a C-section, to mention a few. Scarred tissue obscures the ultrasound waves from reaching the womb hence negative results.

 

What are the Prenatal Care Challenges associated with cryptic pregnancy?

In cryptic pregnancy, you are unaware of the pregnancy and therefore you are likely to fail to get prenatal care. As a result, you may deliver at home without any assistance from an obstetrician. This puts you and your baby at risk.

The growth and development of your fetus in cryptic pregnancy are very slow. Your baby may have intrauterine growth restriction (IUGR), delayed and interrupted growth of the fetus.

In cryptic pregnancy, prenatal complications such as gestational diabetes, preeclampsia/eclampsia, Rhesus, and blood group incompatibility, among others may not be picked putting you and your baby in danger.

The mother may continue with some habits such as smoking, taking teratogenic substances while pregnant which may harm the baby.

There is periodic bleeding in cryptic pregnancy which may result in anemia in pregnancy putting the mother and baby at risk

 

How can NIPT (fetal DNA gender testing, fetal DNA screening) assist in detecting/confirming the presence of a fetus? When is the best time to take these tests?

NIPT is a basic non-invasive, safe, and exceptionally precise screening test that analyzes the free-cell DNA (cfDNA) from the placenta allowing early detection of the birth defect without harming the baby. cfDNA is free-floating and not within the cell.

NIPT can detect cryptic pregnancy. During pregnancy, cfDNA that comes from maternal cells and the placenta mix in the mother’s bloodstream. The cells are released into the maternal blood system throughout pregnancy. There is identity in DNA in placental cells and fetal cells allowing early detection of pregnancy in addition to screening for congenital abnormalities.

Fetal DNA screening is done as early as 9 weeks of gestation. The test is, however, not informative in multiple pregnancies (3 or more fetuses) and in women who have had a bone marrow transplant done.

 

Fetal MRI & Cryptic Pregnancy

Ultrasound is limited in visualizing the fetus in cryptic pregnancy. Ultrasound also fails to pick fetal abnormalities. With current technological advances, fetal magnetic resonance imaging (MRI) has become a safe and efficient method when it comes to the evaluation of the fetal parts especially the brain.

Fetal MRI is useful I cryptic pregnancy because:

• It can detect pregnancy early enough
• Allow evaluation of fetal brain in greater detail compared to ultrasound.
• Confirm fetal abnormality when suspected on ultrasound. 

 

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