Be on the Lookout for Factitious Preterm Labor.

KAMUELA, HAWAII -- It is worth considering a diagnosis of factitious disorder in a pregnant woman who presents three or more times for uterine contractions in the absence of cervical changes, especially if her complaints begin early in pregnancy Dr. Roydon G.F. Steinke suggested at the annual meeting of the Pacific Coast Obstetrical and Gynecological Society.

The Fresno, Calif., ob.gyn. recounted the case of two "labor-intensive" pregnancies in a medical professional who was ultimately found to be simulating uterine contractions by voluntarily tightening the muscles of her abdominal wall every 2-3 minutes for up to 10 hours at a stretch.

"It was incredible that she could keep it up," Dr. Steinke said.

Factitious disorder is described by the American Psychiatric Association as "intentional production or feigning of physical or psychological signs or symptoms" that is not driven by external incentives such as economic gain or the avoidance of legal responsibility.

In the obstetric literature, factitious cases of antepartum hemorrhage, trophoblastic disease, pyrexia, decreased fetal movement, ectopic pregnancy and hyperemesis gravida have been reported. Just three cases of factitious preterm labor have been described, but Dr. Steinke said he suspects there may be significant underrecognition and underreporting of the disorder in this context.

Preterm labor and delivery are among the most serious concerns of obstetricians, prompting aggressive intervention, Dr. Steinke noted.

Since 9% of women who present with contractions in the absence of cervical dilatation will deliver before 35 weeks and 22% deliver before 37 weeks, the symptom is taken very seriously.