‘It’s your fault, doctor’

Diagnosing pregnancy should be easy enough; usually patients suspect their condition well before the doctor does. But as I learned early in my career, this is not always as simple as it seems.

When studying obstetrics as a student, I was allocated a patient who was attending the teaching hospital’s antenatal clinic. I was told she had an antepartum haemorrhage at 28 weeks’ gestation. Although her abdomen was large enough, examination showed that she was not at all pregnant and the bleeding was simply her normal period. On another occasion, an obese patient who was taking the oral contraceptive pill came to see me, reporting that she had missed one period. She was completely unaware of the 29-week-old fetus kicking inside her. Then there was the 46-year-old woman who reported that her ‘change of life’ had arrived. Indeed, it was a change; the woman was in the advanced stages of pregnancy, and termination was no longer an option for her.