title: Serial factitious disorder and Munchausen by proxy in pregnancy.
abstract: Factitious disorder, including Munchausen syndrome, is seldom documented among pregnant patients but can have powerful consequences. We report on a 44-year-old woman who, over a period of two decades, self-induced labour and delivery in five consecutive pregnancies. She precipitated labour by rupturing her own amniotic sac with a fingernail or cervical manipulation, or misappropriating and self-administering prostaglandin suppositories from the hospital unit on which she worked as a nurse. Preterm deliveries resulted in fetal demise in one case and in neonatal intensive care treatment for two of the offspring. One of the surviving children has cerebral palsy attributable to the mother's factitious illness behaviour, which raises the spectre of Munchausen by proxy maltreatment. The patient sought attention and care through the ruses, which have never been uncovered by her obstetric and gynaecologic caregivers. Indeed, she underwent an unnecessary hysterectomy because of the illusion of heavy menstrual bleeding. Most recently, the patient has been engaging in surreptitious autophlebotomy to force blood transfusions.
authors.affiliation: Department of Psychiatry and Behavioral Medicine, The Unoversity of Alabama, Tuscaloosa, Al 35243-5351, USA. mdf@myself.com
authors.forename: M D
authors.initials: MD
authors.lastname: Feldman
authors.forename: J C
authors.initials: JC
authors.lastname: Hamilton
mesh_terms: D000028:Abortion, Induced / Q000523:psychology*; D000328:Adult; D005162:Factitious Disorders / Q000523:psychology; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000523:psychology; D006801:Humans; D016735:Munchausen Syndrome by Proxy / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D016728:Self-Injurious Behavior / Q000523:psychology*