Two North Carolina doctors have been reprimanded for performing a caesarian on a woman, only to discover she wasn't pregnant at all.
The woman reportedly appeared at the hospital with her husband asking for a C-section. A resident in charge made the pregnancy diagnosis and doctors agreed to surgery after trying to induce labor for two days.
Neither doctor independently confirmed the pregnancy.
In January, after studying the case for more than a year, the North Carolina Medical Board sent "letters of concern," the lowest level of discipline, to Dr. Gerianne Geszler, who was the on-call physician, and Dr. Dorrette Grant, who performed the caesarian in 2008.
When they saw an empty uterus, they "closed her back up," Geszler told ABC News. Pseudocyesis can "fool people," said Paul Paulman, assistant dean for clinical skills and quality at the University of Nebraska College of Medicine, "but you open someone's abdomen, you make darn sure you know what you're doing," he said. "It's a potentially life-changing event."
Paulman wrote about a similar 1990 case in the Journal of Family Practice.
The medical board in North Carolina said the resident at Cape Fear Medical Center did not have enough experience to make the pregnancy diagnosis and doctors should have conducted their own exam.
Dena Konkel, assistant director of public affairs for the medical board, said the case was "unique."
"The board was mostly concerned about the management of patient care," she said. "It may have fallen below the standard of care."
"Some would argue that this is not disciplinary in nature -- it doesn't limit their ability to practice medicine," said Konkel. But, "it creates a public record, something that can be looked up and read about what happened."
Neither doctor has been disciplined publicly before. Both still practice medicine, but with a warning from the board that similar complaints could lead to formal disciplinary proceedings.
Grant did not return calls from ABCNews.com, but the board's Web site indicates she is still delivering babies at Women's Health Haven Obstetrics and Gynecology.
"I do not want to criticize anyone else involved with this case," said Geszler. "I was covering the residents when the patient arrived, and she reported the case to me. I did not actually see the patient as this is not necessarily a protocol that the attending examine the patient."
She said the ob-gyn resident was a medical doctor and trained in ultrasound.
"Residency and supervision of residents is very complicated," said Geszler, who is now practicing at Breezewood's Center for Health and Restoration. "To let them make appropriate evaluation and decisions, yet without harm to the patient. Do you second guess everything? Do you repeat everything?"
Other doctors familiar with pseudocyesis, say the disorder can be deceptive.
Although it is a psychiatric condition, women can have all the physiological symptoms of pregnancy -- cessation of menstruation, distended abdomen, swollen breasts, morning sickness and food cravings, and even labor pains.
Pseudocyesis is considered rare, occurring at a rate of 1 to 6 for every 22,000 births. It often strikes women with a "strong desire" to become pregnant, according to Paulman.