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FORENSIC ASPECTS OF PSEUDOCYESIS: A CASE REPORT
Como citar: Oliveira LS, Junior HBC. FORENSIC ASPECTS OF PSEUDOCYESIS: A CASE REPORT. Persp Med Legal Pericia Med. Vol. 11, 2026; 260535.
https://dx.doi.org/10.47005/260535
Recebido em 15/01/2026
Aceito em 20/01/2026
The authors report no conflict of interest.
FORENSIC ASPECTS OF PSEUDOCYESIS: A CASE REPORT
Resumo
A pseudociese é uma condição rara caracterizada pela presença de sinais e sintomas sugestivos de gestação na ausência de gravidez real, podendo gerar importantes repercussões clínicas, psicológicas e médico-legais (1,2). No contexto da medicina legal, sua identificação é fundamental para a elucidação de alegações de gestação com possíveis implicações jurídicas (5,6). O presente estudo tem como objetivo relatar um caso de pseudociese avaliado em contexto médico-legal, destacando a importância da investigação pericial e do diagnóstico diferencial (4). Trata-se de paciente do sexo feminino, adulta, com alegação de gestação avançada, acompanhada de sintomas compatíveis com gravidez, porém sem confirmação por exames clínicos e complementares. A avaliação incluiu anamnese, exame físico e análise de exames laboratoriais e de imagem, que não evidenciaram gestação em curso. A discrepância entre a convicção subjetiva da paciente e a ausência de achados objetivos sustentou a hipótese diagnóstica de pseudociese, conforme critérios clínicos e psiquiátricos descritos na literatura (3,4). O caso evidencia a relevância da atuação técnica e ética do perito médico, bem como a necessidade de investigação criteriosa baseada em evidências científicas, a fim de garantir segurança jurídica e adequada condução dos casos envolvendo alegações de gestação no âmbito pericial (6–8).
Palavras Chave: Pseudociese; Medicina legal; Perícia médica; Gravidez psicológica; Diagnóstico diferencial.
Abstract
Pseudocyesis is a rare condition characterized by the presence of signs and symptoms suggestive of pregnancy in the absence of an actual gestation, potentially leading to significant clinical, psychological, and medico-legal repercussions (1,2). In the context of legal medicine, its identification is essential for clarifying allegations of pregnancy with possible legal implications (5,6). This study aims to report a case of pseudocyesis evaluated in a medico-legal setting, highlighting the importance of forensic investigation and differential diagnosis (4). The case involves an adult female patient who alleged an advanced pregnancy and presented symptoms compatible with gestation, without confirmation by clinical or complementary examinations. The assessment included anamnesis, physical examination, and analysis of laboratory and imaging tests, none of which demonstrated an ongoing pregnancy. The discrepancy between the patient’s subjective conviction and the absence of objective findings supported the diagnostic hypothesis of pseudocyesis, according to established clinical and psychiatric criteria (3,4). This case underscores the relevance of the technical and ethical role of the forensic physician, as well as the need for a thorough investigation based on scientific evidence to ensure legal certainty and appropriate management of cases involving allegations of pregnancy in the forensic context (6–8).
Keywords (MeSH): Pseudocyesis; Legal medicine; Medical expertise; Psychological pregnancy; Differential diagnosis.
Forensic Aspects of Pseudocyesis: A Case Report
INTRODUCTION
Pseudocyesis, also referred to as psychological pregnancy or phantom pregnancy, is a rare condition characterized by the presence of physical and psychological signs and symptoms compatible with pregnancy in the absence of an actual gestation. It is a complex phenomenon in which psychological, psychiatric, endocrinological, and sociocultural factors interact significantly, producing somatic changes that may convincingly simulate a gestational state (O’Grady & Rosenthal, 2021; Sadock et al., 2022). Although more frequently described in the fields of gynecology and psychiatry, pseudocyesis has direct relevance to legal medicine and forensic medical practice, particularly when its manifestations arise in judicial, administrative, or criminal contexts (França, 2024).
In the field of legal medicine, the correct identification of pseudocyesis is essential for clarifying situations involving alleged pregnancy associated with legal demands, such as judicial disputes, investigations of alleged sexual violence, applications for social security benefits, criminal accusations, or questions regarding reproductive capacity (Croce & Croce Júnior, 2023; Brazil, 2022). In such circumstances, the forensic physician plays a central role and must conduct a rigorous technical investigation based on clinical, laboratory, and imaging criteria, as well as a careful analysis of the psychosocial context of the examinee, maintaining an ethical, impartial stance grounded in scientific evidence (França, 2024).
The forensic investigation of pseudocyesis requires a multidisciplinary and unbiased approach, as clinical signs may include amenorrhea, abdominal enlargement, galactorrhea, nausea, subjective perception of fetal movements, and intense emotional changes, which, in isolation, do not allow confirmation of pregnancy (Sadock et al., 2022; Kaplan & Sadock, 2021). Therefore, forensic medical evaluation must rely on objective complementary examinations, such as hormonal assays and imaging methods—especially obstetric ultrasonography—while also considering the possibility of associated psychiatric disorders, including somatoform and psychotic disorders, without resorting to value judgments or stigmatizing interpretations (O’Grady & Rosenthal, 2021; WHO, 2023).
The relevance of legal medicine in this context lies primarily in its ability to differentiate between organic conditions, psychopathological states, and simulation, thereby ensuring legal certainty and protecting both the examined individual and the institutions involved (Croce & Croce Júnior, 2023). Diagnostic errors or inadequate forensic conduct may result in erroneous judicial decisions, revictimization of the examinee, or undue legal accountability, reinforcing the need for technically sound, careful, and well-documented forensic practice (França, 2024; Brazil, 2022).
Thus, the case report represents a valuable scientific tool for discussing pseudocyesis from a forensic perspective, allowing the sharing of practical experiences, diagnostic challenges, and medico-legal investigative strategies applicable to routine forensic practice (Karch, 2021). This report aims to describe a case of pseudocyesis evaluated in a forensic setting, highlighting the importance of appropriate investigation and the role of legal medicine and forensic medical expertise in the correct management, interpretation, and technical substantiation of such cases.
CASE PRESENTATION
An adult female patient was referred for medico-legal evaluation following an allegation of an ongoing pregnancy in the context of prior care at a private hospital in the state capital. The patient reported signs and symptoms described as compatible with advanced pregnancy, although previous clinical and complementary examinations had not confirmed the existence of gestation. The forensic evaluation aimed to clarify the presence or absence of a gestational state and to discuss its medico-legal implications.
During the clinical interview, the patient provided a confused account, stating that this was her third pregnancy. She reported regular prenatal follow-up at a private healthcare facility. According to her report, on January 4, 2026, she sought hospital care due to abdominal pain and, given an estimated gestational age of approximately nine months, was admitted for obstetric hospitalization. After initial examinations, she was transferred for inpatient care.
The patient reported that at approximately 10:00 p.m., she was taken to the delivery room, where she stated that she gave birth to a fetus that, according to information received in the hospital environment, was born without signs of life. She reported no subsequent contact with the newborn at the time of evaluation and did not present any documentation confirming delivery or birth.
Regarding obstetric history, the patient reported previous pregnancies with cesarean deliveries, as well as a history of miscarriage, with the last delivery occurring approximately 15 years earlier.
On physical examination, the patient was in good general condition, although emotionally distressed, with occasional crying during the evaluation. The breasts were of size and volume compatible with age, and manual expression resulted in the discharge of a small amount of bilateral milky secretion. The abdomen was globose, moderately distended, and tender on palpation, with difficulty delineating the uterine fundus. Examination of the external genitalia revealed a vulva with an appearance compatible with age and no traumatic lesions. The vagina showed mild edema without significant traumatic lesions, and a small amount of serosanguineous secretion was observed during vaginal examination; assessment of the uterine fundus was limited due to the patient’s pain response.
Complementary examinations were reviewed, including an obstetric ultrasound performed on January 7, 2026, as well as laboratory results included in the medical record. The beta-hCG assay requested in the forensic context was not initially performed due to the patient’s departure before sample collection; however, subsequent available examinations showed no evidence of an ongoing pregnancy. Obstetric ultrasonography demonstrated the absence of a gestational sac, embryo, or fetus, ruling out the possibility of a current pregnancy.
The discrepancy between the patient’s reported symptoms, her subjective conviction of pregnancy, and the absence of objective findings supported the diagnostic hypothesis of pseudocyesis. The clinical and complementary findings observed in this case are consistent with this condition, which is characterized by somatic and emotional manifestations suggestive of pregnancy without organic confirmation.
DISCUSSION
Pseudocyesis represents a significant diagnostic challenge in both clinical practice and the medico-legal context due to the intensity and plausibility of the signs and symptoms presented, which may convincingly simulate a true pregnancy (Sadock et al., 2022). In the forensic setting, this condition assumes even greater importance, as allegations of pregnancy may have substantial legal, administrative, and criminal repercussions, requiring the forensic physician to adopt a rigorous, evidence-based technical approach.
From a pathophysiological standpoint, pseudocyesis is associated with complex interactions between psychological factors and neuroendocrine alterations capable of triggering manifestations such as amenorrhea, abdominal enlargement, galactorrhea, and subjective perception of fetal movements, even in the absence of actual gestation (Kaplan & Sadock, 2021; O’Grady & Rosenthal, 2021). These manifestations explain the strong conviction observed in many patients and reinforce the need for a careful forensic approach that avoids premature or stigmatizing interpretations.
In the context of legal medicine, the differential diagnosis between pseudocyesis, true pregnancy, simulation, and other psychiatric disorders is an essential step in forensic investigation. The literature emphasizes that pseudocyesis should not be confused with conscious simulation, as in most cases the patient genuinely believes she is pregnant, which differs substantially from situations involving deliberate intent to deceive or obtain secondary gain (França, 2024; Croce & Croce Júnior, 2023).
Forensic conclusions must therefore be based on objective findings, particularly laboratory tests and imaging methods, with ultrasonography highlighted as the gold standard for excluding an ongoing pregnancy (Brazil, 2022). The absence of gestational evidence in these examinations, combined with the presence of suggestive symptomatology, supports the diagnostic hypothesis of pseudocyesis, as observed in the present case.
Another relevant aspect concerns the limits of forensic practice. As established in medico-legal doctrine, the forensic physician must restrict their role to the technical analysis of facts and the issuance of conclusions based on objective data, avoiding definitive psychiatric diagnoses when these exceed the scope of the requested forensic evaluation (França, 2024). This posture is essential to preserve professional ethics, impartiality, and legal certainty.
Moreover, inappropriate handling of pseudocyesis cases may result in revictimization of the examinee, worsening psychological distress, and erroneous judicial decisions, underscoring the importance of technical training for forensic physicians and the adoption of clear investigative protocols (WHO, 2023). Recognition of this condition in the forensic context contributes to appropriate case management and enables referral for clinical or psychiatric care when indicated, without compromising the forensic function.
Thus, this case report highlights the relevance of pseudocyesis as a differential diagnosis in allegations of pregnancy within the forensic context and reinforces the central role of legal medicine and forensic medical expertise in the technical clarification of such cases. Evidence-based practice, combined with respect for ethical and legal boundaries, is fundamental to ensuring fair and scientifically grounded decisions.
CONCLUSION
This case report demonstrates pseudocyesis as a clinically significant condition within the context of legal medicine and forensic medical practice, particularly in situations involving allegations of pregnancy with potential legal repercussions. The similarity between the signs and symptoms presented and those observed in true pregnancy underscores the need for careful forensic investigation based on objective findings and reliable diagnostic methods.
The role of the forensic physician proved essential in the accurate clarification of the case, allowing the exclusion of pregnancy and the technical, impartial support of the diagnostic hypothesis of pseudocyesis without exceeding the ethical and legal limits of forensic practice. Such an approach contributes to legal certainty, prevents erroneous decisions, and reduces the risk of revictimization of the examinee.
In conclusion, recognition of pseudocyesis as a differential diagnosis in forensic contexts is essential for contemporary legal medicine, emphasizing the importance of technical training for forensic physicians and the integration of clinical, psychiatric, and medico-legal knowledge in the management of these cases.
References
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