Conservative management of fetus papyraceus: a report of two cases

Fetus papyraceous disguised as compound presentation: A case report

Introduction

and importance: Fetus papyraceous (FP) is a rare condition that describes a mummified fetus in a multiple gestation pregnancy in which one fetus dies and becomes flattened between the membranes of the other fetus and uterine wall. Compound presentation occurs when the fetus's arm or leg is next to the main presenting part, very often the vertex is combined with arm presentation. A severe complication can occur in mother and child in such cases.

Case presentation

We report a case of incidental finding of fetus papyraceous disguised as a compound presentation during normal delivery which was managed successfully without any complication.

Discussion

Regular antenatal chorionicity assessment is essential for early diagnosis of fetus papyraceous and reduces mortality and morbidity in the surviving fetus.

Conclusion

Early identification of such cases is necessary as it is associated with severe complications like preterm labor, infection from a retained fetus, severe puerperal hemorrhage, consumptive coagulopathy like disseminated intravascular coagulation, and obstruction by a low-lying fetus papyraceus producing dystocia leading to cesarean birth.

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Fetus papyraceous mimicking as compound presentation leading to the diagnostic dilemma.

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Which has hazardous effects on the life of the mother and surviving twin.

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Successful management and outcome of mother and surviving twin with no complication.

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Routine serial ultrasound examination using modern ultrasound can aid in early diagnosis of fetus papyraceous.

Fetus papyraceus causing dystocia in a rural setting: a case report

Introduction

Fetus papyraceus is a rare condition which describes a mummified fetus in a multiple gestation pregnancy in which one fetus dies and becomes flattened between the membranes of the other fetus and uterine wall. We report a case of fetus papyraceus diagnosed during labor as a result of arrested descent.

Case presentation

A 23-year-old Sukuma woman, gravida 2, para 1 presented to an maternity emergency unit of Sengerema Designated District hospital at a gestation age of 35⁺⁵ weeks as a referral from a rural health center due to arrested descent despite being in active labor for the past 8 hours. On vaginal examination, her cervix was 6cm dilated; fully effaced, presenting part was at station −3. A sharp and solid object-like thing was felt on the right side of her cervix. Due to uncertainty of the presenting part together with arrested descent, a decision was reached to deliver her by caesarean section. A twin gestation was identified during caesarean section: one being a male baby in cephalic presentation, weighing 1.9kg with Apgar score 8 in first minute and 9 in fifth minute with its own normal placenta and membranes. There was another atrophied placenta with calcifications without a cord and with mummified fetal bones on the anterior to the lower segment at the level of the internal orifice of the uterus. The atrophied placenta and mummified fetal bones weighed 200gms. One unit of blood was transfused intraoperatively due to severe anemia prior to surgery. Both the mother and the baby were discharged home in good condition.

Conclusions

The primary concern for fetus papyraceus is its effect on the surviving fetus and on the mother. To avoid possible complications, the intrauterine diagnosis of fetus papyraceus by serial ultrasound examinations and routine placental examination to search for fetus papyraceus is mandatory.