April 19, 2015 at 10:57 AM

This is an interesting fiction story set-up with many little parts and lots of directions in which you can go. As for the medical aspects, there is nothing in the set-up here that is impossible or unrealistic. Pregnancy rarely happens over age 50, but it’s not unheard of. Today, it’s often the result of using fertility drugs. The beginning stages of menopause can be intermittent, and mimic complete menopause. Eggs can still be released, and hormones can still support the early stages of fetal development. The odds of such a pregnancy are very low, but this is the type of unlikely transforming life event that good fiction is often about.

The ER would not suspect or look for a pregnancy in this woman. However, it is likely they’d do an abdominal CT scan (and maybe an ultrasound) as part of a workup for a major infection of unknown origin. Either of the previously mentioned tests would visualize the growing fetus, and discover the pregnancy.

Your patient might be treated with IV fluids for rehydration, and antibiotics for a bacterial infection and/or pneumonia. She’d be kept in the hospital for a few days for observation and IV medications. Keeping her in the hospital is justified, because she’s at risk for a massive infection (septic shock) or severe pneumonia leading to respiratory failure. And now, she’s an elderly pregnant woman, and at high risk for pregnancy related complications. This story will make an interesting graphic novel, and be a challenge to illustrate!

H.S. Clark, MD

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