Unrecognised Second-Trimester Pregnancy With Fetal Demise Presenting as Acute Abdomen and a Negative Pregnancy Test

TL;DR

A woman with a missed pregnancy and fetal demise showed negative pregnancy test results, emphasizing the need for imaging in such cases.

Contribution

This case highlights the possibility of false-negative pregnancy tests in advanced fetal demise and the importance of early imaging.

Findings

A negative urine pregnancy test can occur in cases of fetal demise due to declining hCG levels.

Imaging is crucial for diagnosing unrecognized pregnancies with fetal demise.

Clinical suspicion is essential when symptoms suggest pregnancy despite negative tests.

Abstract

A woman in her early 20s presented with abdominal pain and a heavy period, unaware that she was 18 weeks pregnant. Despite a negative urine pregnancy test, imaging revealed intrauterine fetal demise. This rare case highlights the importance of maintaining clinical suspicion and performing early imaging, as pregnancy tests may yield false-negative results in cases of miscarriage and fetal demise. Human chorionic gonadotropin (hCG) is produced by the placenta, but when a pregnancy fails to develop normally, such as in miscarriage, hCG levels may be lower than expected or decline, leading to negative test results despite advanced gestation.

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