A new development in the disturbing case of a patient becoming pregnant and giving birth while in a vegetative state sheds some light on why staff at the Arizona nursing facility did not realize the 29-year-old woman was pregnant.

Fox 10 has obtained court documents showing that the patient, who had been in a vegetative state for 10 years following a near-drowning incident, had a medical examination in April –– with no indication she was examined anytime between then and when she gave birth on December 29.

The woman would likely have been in the early stages of pregnancy when she was given an “external” examination on April 16.

The court documents, which were reportedly taken from an annual report submitted by the patient’s mother and legal guardian, show that the patient at Hacienda HealthCare was given an “external” examination on April 16, and that the examining doctor found “no change” in her health.

It is not known if the report was submitted as part of the investigation into the apparent rape that led to the pregnancy, but the Fox 10 report indicates that the patient was not examined again before giving birth.

The baby, reportedly a boy, is in the care of the patient’s family, reportedly members of the San Carlos Apache tribe in southeastern Arizona.

Details about the ongoing investigation at Hacienda HealthCare have been minimal, but Phoenix Police Sergeant Tommy Thompson reportedly said at a news conference on Thursday that his department is collecting DNA samples from employees at the nursing facility. It is not known if the patient who gave birth is still there or if she has been relocated.

Fox 10 reportedly spoke to doctors in fetal medicine who said it was possible that patients in a persistent vegetative state may not show obvious signs of pregnancy, but the report does not provide any further specifics.