Last week’s episode of Call The Midwife featured a heartbreaking storyline which shed light on a rare pregnancy phenomenon known as lithopedion – when a woman is forced to deliver a calcified foetus.
The episode saw a woman who had been unable to have children being visited by a doctor after experiencing pain and incontinence.
During surgery to remove what was thought to be a ‘mass’, the surgeon discovered the woman had been carrying a calcified foetus – or ‘stone baby’ – for more than three decades.
The TV drama, currently set in the 1970s, draws on a real phenomenon which has around 300 documented cases.
The word lithopedion derives from the Greek words ‘litho’ meaning stone and ‘pedion’ meaning child.
Dr Deborah Lee, a sexual and reproductive health and menopause specialist at Dr Fox Online Pharmacy, told the Daily Mail that lithopedions are incredibly rare because of the conditions it needs to develop.
She said: ‘A lithopedion is sometimes called a “stone baby” and is a very rare complication of an ectopic pregnancy, in which the dead foetus is located inside the abdomen, and over time, has become calcified.’
An ectopic pregnancy – which accounts for around one per cent of pregnancies – happens when an embryo grows outside of the uterus.
Last week’s episode of Call The Midwife featured a heartbreaking storyline which shed light on the rare pregnancy phenomenon known as lithopedion
The TV drama, set in the 1970s, draws on a real phenomenon which has around 300 documented cases
The likelihood of a pregnancy developing outside the uterus is one in 11,000 pregnancies, said Dr Lee.
The uterus is the only organ designed to stretch, supply blood and safely support a developing pregnancy and therefore, the chance of a baby surviving an ectopic pregnancy is very rare.
Around 90 per cent of ectopic pregnancies occur in the fallopian tube, and the remaining 10 per cent can occur anywhere in the abdomen, including the ovary, the cervix and at the site of the scar from a previous Caesarean section.
When an ectopic pregnancy fails, the tissue is generally resorbed as part of the mother’s natural healing processes.
If the pregnancy is less than 12 weeks of gestation, the foetal skeleton is made up of cartilage, which can be reabsorbed by the mother’s body.
However, if the foetus is more than 12 weeks of gestation, the skeleton contains bone, and is too large for the body to reabsorb.
The maternal immune system recognises the dead foetus as a foreign body and covers it with calcium to shield the mother from infection. This is a type of mummification.
This mass then remains in situ for months or years unless it is discovered and removed by medical intervention.
Only 1.5 to 1.8 per cent of these pregnancies will become a lithopedion and only around 330 lithopedions have been reported in the world’s medical literature.
The earliest known lithopedion was found in an archaeological excavation at Bering Sinkhole, on the Edwards Plateau in Kerr County, Texas, and dated to 1100 BC.
A sagittal CT scan showing a lithopedion, also known as a ‘stone baby’, is pictured
A lithopedion is one of the rarest medical conditions ever recorded. Pictured: A radiograph showing a lithopedion in a mother’s abdomen
Dr Lee explains that while a lithopedion can remain asymptomatic and undetected for up to 60 years, it may cause a wide range of gastrointestinal or genitourinary symptoms.
‘These are often due to pressure of the hard mass on surrounding structures, causing abdominal pain – usually chronic and aching – urinary frequency or constipation,’ she said.
‘The mass can also become infected, resulting in a pelvic abscess.’
Research has identified that the risk of lithopedion is greater in women from poor socio-economic backgrounds with generally lower levels of health knowledge and awareness, and who have limited access to prenatal care.
‘Strong religious beliefs or cultural influences may deter women from seeking help in early pregnancy,’ said Dr Lee.
In some instances, particularly where access to healthcare is limited, a pregnancy may go entirely unnoticed. Cases without symptoms are often discovered after death during examination.
One case, which was discovered in 2023, involved a mother who died from severe malnutrition after carrying an unborn foetus for around nine years inside her body.
The woman, originally from the Congo, visited doctors in New York complaining of stomach cramps, indigestion and a gurgling sound after eating.
Scans revealed the 50-year-old had a ‘stone baby’ compressed by her intestines, which was attributed to a miscarriage nine years prior.
The patient refused treatment, saying she believed her health condition was related to a ‘spell’ that someone cast on her in Africa. The woman died 14 months after arriving in the United States.
In these cases, death may eventually be caused by tissue degradation leading to cardiac arrest or cardiac arrhythmia, an irregular heartbeat. Other causes include an infection brought on by a weakened immune system.
For this woman, the ‘stone baby’ kept compressing the intestine. This caused blockages, meaning her body was no longer able to absorb vital nutrients, leading to starvation.
The above image displays a foetus with a well-developed skeleton within the abdominal cavity, outside the uterus
In another example, a pensioner died in Brazil after having surgery to remove a ‘stone baby’ she had been carrying inside her for around 56 years.
Daniela Almeida Vera, 81, passed away after medics detected the lithopedion during a scan after she complained of stomach pains.
They concluded she had been carrying the dead foetus in her body since her last pregnancy more than five decades ago.
‘These days, advances in prenatal and antenatal care, with detailed imaging, mean that lithopedion is even rarer than it used to be,’ says Dr Lee.
‘Health professionals are well trained and know how to diagnose and differentiate between an intrauterine and an extrauterine pregnancy and provide the correct management. Women also have greater access to health care.
‘If a woman has a positive pregnancy test, but the pregnancy cannot be located, this is called a pregnancy of unknown location (PUL).
‘There is a strict protocol to follow, which entails having repeat blood tests for B-HCG levels and follow-up scans. If an extrauterine pregnancy is diagnosed this is treated either medically, using the drug methotrexate, or surgically.
‘It’s always vital for any woman with a positive pregnancy test to attend all her clinic appointments and scans, and follow medical advice carefully, right through until the outcome of the pregnancy is known and she is discharged.’
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