Doctor's Review: Medicine on the Move

September 2, 2014
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Fetal rock

Forget 40 weeks. Hundreds of mothers have carried lithopedia, or stone babies, for as long as 50 years.

When all goes smoothly, childbirth is arguably the most joyous and miraculous process in the realm of human experience, as well as one of the most rewarding facets of

 

modern medical practice. It’s only when things go wrong that we are reminded of the underlying fragility of reproduction, especially on those occasions when simple happenstance leads to a poor outcome.

Most Canadian GPs and obstetricians have had heavily pregnant patients come in half-complaining of the sensation that they’re carrying a bowling ball instead of a baby — a great many of you have surely experienced the feeling yourselves. Sometimes, however, the association can be far more apt than amusing. Among the rarest and most bizarre occurrence among the many obstetrical oddities recorded over the millennia is certainly lithopedia.


 

Against all odds

Taken quite simply from the Greek words for “stone” and “child,” lithopedia develops only after an exceedingly unlikely series of biological blunders. The first step in the chain is ectopic pregnancy — a fairly rare occurrence to begin with, with an incidence of about one to two percent of all conceptions. Furthermore, though 95 percent of all extra-uterine pregnancies implant in the fallopian tubes, some do not. Almost always, early detection and/or rupture will prevent the continued development of the fetus in the tubes, but when a pregnancy implants in the abdomen, for example, and the placenta attaches to vital organs, establishing a good blood supply — unbeknownst to both mother and MD — the stage is set for a possible lithopedion.

Usually, the fetus won’t survive under these conditions and dies when it’s still small enough to be reabsorbed by the body. If, however, the fetus grows to a large enough size and then expires without incident, the body will occasionally treat the baby as a foreign object and potentially dangerous source of infection, encasing it in layers of calcium until it’s virtually entombed in stone within its mother. Like a pearl in an oyster, since it no longer poses a threat, these stone babies can remain in situ for years.

It comes as no surprise that fewer than 300 stone babies have been recorded in medical literature. Even among these, the majority are believed unlikely to be true lithopedia, but rather the result of a congenital anomaly like syphilis or some other constellation of severe birth defects.


 

Mothers of mummies

The first mention of a lithopedion in literature comes courtesy of the 10th-century Spanish-Arabian physician and surgeon, Albucasis (936-1013). He described the discovery of a stone baby briefly in his life’s work, the 30-volume Kitab al-Tasrif. But this Andalusian lithopedion was certainly not the first; within the last century, archeology has revealed several other, earlier stone babies. One case — dating to 1100 BCE — was believed to be the oldest, until recently.

In the 1990s, during a dig at the ancient Bering Sinkhole in Texas, archeologist and University of Texas professor Leland Bement unearthed the well-preserved remains of what at first appeared to be a woman bearing some sort of mummified baby. Further inspection, however, revealed something far more interesting. Paleopathologists Christine and Bruce Rothschild confirmed it: a 3100-year-old lithopedion. Similarly, a fourth-century fetal find at Costebelle, France, in 1996, was initially deemed a case of congenital syphilis but was actually confirmed to be a seven-month-old calcified fetus.


 

A lose lose situation

The 16th century was a big one for lithopedion with a few different doctors reporting credible cases. Cordseus, Horstius and N. Polinus described instances of stone babies remaining in their mothers’ abdomens for up to 28 years. Strasbourg physician Israel Spach included an illustration of a lithopedion in his 1557 text Gynaeciorum. Almost as chilling was his overly poetic account of the situation:

“Deucalion cast stones behind him and thus fashioned our tender race from the hard marble. How comes it that nowadays, by a reversal of things, the tender body of a little babe has limbs nearer akin to stone?”

Over the next four centuries, many more medical professionals followed suit and described strange cases of their own. But with no way to understand how a baby could end up entombed within its mother’s stomach, scientists of the past had to come up with seriously creative philosophical and religious explanations. Of course, as scientific understanding progressed, finally separating fact from superstition, the true processes leading to lithopedia gradually came to be understood.

But even as time marched on, treating extra-uterine pregnancies that had progressed to a significant size and/or viability remained a complicated conundrum. Before the advent of obstetric ultrasonography in the 1960s, there was no way to see inside the womb and therefore no way to diagnose ectopic pregnancies until it was too late. In truth, even if doctors had been able to steal a peek inside women’s bodies, the serious surgical process of removing a fetus, living or dead, along with its placenta and accompanying intricate blood-supply network, was unlikely to result in a positive outcome for anyone.

Fortunately, in the past 50 years or so, better access to medical care and prenatal testing means that ectopic pregnancies — and the lithopedia that so rarely result from them — are unlikely to go unnoticed for long. Still, since there will always be cases of women who don’t even know that they’re pregnant, the odd instance of the phenomenon will continue to pop up here there, especially in the developing world.


 

Delayed deliveries

Recently, in Zaire, a lithopedion was removed from the abdomen of a 37-year-old woman. After surgeons excised the mass — initially thought to be a large uterine fibroid — it was determined to be a stone baby. The fetus had survived, undetected, in its mother’s abdomen until about 32 weeks and there it remained for three years more. Although the mother said she knew about the pregnancy, when “the baby never came out,” she simply went on with her day-to-day life. Other credible cases in recent literature include women from all over the world who’ve remained “pregnant” with a lithopedion for 10, 18 and even 39 years. And then there’s the mother of them all...

In 2001, a 70-something-year-old Moroccan woman from Casablanca named Zahra Aboutalib had the dubious distinction of making the medical history books thanks to her stone baby. As a young, pregnant woman in stalled labour in 1955, she feared the prospect of a C-section so deeply — having just witnessed another woman die in front of her as a result of the surgery — that she fled the hospital and went home. Eventually, her pain subsided, but Zahra never returned to the hospital, even though her baby never showed up either.

In the end, it might have been for the best since, unbeknownst to her at the time, her pregnancy had progressed outside the womb; as a result, any attempt at a Caesarian section would likely have resulted in her bleeding to death. Though she remained mostly unbothered by her macabre burden over the decades, one day, the sudden onset of abdominal pain and her son’s urging finally led her to back the doctor. The solid mass found by her physician was initially thought to be an ovarian tumor, but subsequent scans revealed a mystery that couldn’t be solved locally. She was sent to experts in France, where surgeons eventually removed a seven-pound lithopedion from her abdomen. Zahra had been carrying her stone baby for close to half a century.

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