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Pregnancy Bliss | Reproductive Health Hub

‘Hidden’ pregnancy

Question:  What is denial of pregnancy? Is it possible for a woman to deliver a baby without knowing she was pregnant? That is without the symptoms of pregnancy like bulging abdomen, nausea, baby movements etc? Is it possible to have a pregnancy hidden in the waist or hip and which cannot be easily seen by abdominal scans?

There is a real live story of a woman who gave birth 3 months after delivering the first baby. In fact she did not know that she had another baby in her only to go to the hospital and came back with the second baby? where could the second baby have been? In the same womb or somewhere outside the womb? G. (Kenya)

Answer: There are three concepts you have touched upon, all of which are discussed in more detail in respective sections on this site. I will briefly touch upon each of them. There is such a thing as a ‘concealed pregnancy’. This happens in all parts of the world but is more prevalent in some societies than others. In those societies where pregnancy out of wedlock is regarded as unacceptable, pregnancy concealment among girls, young women and even widows is not uncommon. Social norms in those societies mean these women have to find ways to escape the consequences of such a pregnancy and concealment as well as illegal abortions are some of the ways they resort to. It is not that a woman does not know she is pregnant. She just does not want to be found out. Whilst this is much more common in developing countries, similar cases are occasionally reported in developed countries as this case recently reported in France illustrates.

The other concept you alluded to is a twin pregnancy where twins are born at different dates, sometimes weeks or months apart. This does happen but is fairly rare. When twins are in separate sacs and have different placentas, one of them can be born early, say at 28 - 30 weeks and the other one stay in the womb until term, 10-12 weeks later. This has been known to happen. Both twins will be in the womb and a scan will identify both without any problem. It is, however, more common for one twin to be miscarried in the first trimester and the other one to continue as a singleton until term. That is a great deal commoner.

The other issue you touched upon is suggestive of an ectopic pregnancy that continues to term and delivery. This does occasionally happen but the pregnancy will have to be abdominal rather than in those places you suggested. The placenta can attach to the abdominal wall and the baby grow to term or near term. The woman will have all the usual pregnancy signs and symptoms even though the baby is not in the womb. To deliver such a baby, an abdominal operation will be required. In those resource-poor places where facilities are not available, this is likely not be recognised until the end and this situation can lead to catastrophic internal bleeding where both mother and baby are lost. Normal delivery is of-course not possible since the baby is not in the womb. Abdominal ectopic pregnancy is discussed here.

Azathioprine  (Imuran) in pregnancy

Question:  I take Imuran for my lupus and my partner and I are planning to start a family. My doctor thinks I will have to continue taking this drug. Is it safe to do so? P.Q. (USA)

Answer: Your doctor is right. The advice to those women using this drug, the generic name of which is Azathioprine, is that they should continue using it during pregnancy because the risk to the fetus is considered relatively small. Azathioprine is used for a variety of autoimmune diseases such as systemic lupus erythromatosus (SLE) that you have as well as by those who have had organ transplants. The risk to a pregnancy posed by autoimmune diseases when not properly controlled is a great deal bigger than the potential risk from using Azathioprine. There is, in fact, no evidence in humans that its use in pregnancy can lead to birth defects. There is a small risk of preterm delivery. However, the risk of pregnancy loss (miscarriage) with uncontrolled SLE is much higher.

Home birth; previous caesarean section

Question:  Can I have a home birth if my last delivery was a caesarean? I have two older children who were normal births in hospital. T. (UK)

Answer: A previous caesarean section is regarded as a risk factor. Whilst a previous caesarean section is not an absolute contra-indication for a home birth, all other factors  (reason for previous caesarean, your general health, estimated fetal size and many others) need to be taken into account and a careful assessment made on the feasibility and safety of a planned home birth. If your midwife and doctor are satisfied that the risk is small and back-up support arrangements (just in case) are in place and adequate, then you can have what you desire. Best wishes.

Conceiving when already pregnant

Question:  I am 1.5 months pregnant.Now that i am pregnant, can i get pregnant again if i am having unprotected sex with my long term partner? Many thanks in advance. K. (Bermuda)

Answer: Congratulations on your pregnancy. If I understand you correctly, you are now pregnant and around 6 weeks gestation and want to know if another conception on top of this can take place. If that was the question then the answer is a definite no. It is not possible for a woman to ovulate when already pregnant and therefore conception is impossible.

There has been a handful of cases in medical history where a woman has carried a twin pregnancy from two different conceptions. This is extremely rare and usually results from acts of coitus taking place at most a few hours apart. Several days or weeks after conception, another conception is, by all intents and purposes, impossible