# 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.

## Key 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.