Publication:

Twin pregnancy complicated by fetus papyraceous: a case report

Fetus papyraceous is a rare complication of multiple gestation resulting from intrauterine demise of one fetus during early or mid-pregnancy followed by compression by the growing co twin. We report a case of a 21-year-old primigravida with dichorionic diamniotic twin pregnancy complicated by intrauterine demise of one twin at approximately 17 weeks gestation. Serial ultrasonography revealed a macerated compressed fetus consistent with fetus papyraceous while the surviving twin continued to demonstrate normal growth parameters whereas fetus papyraceous was twin A and was the presenting fetus. A conservative approach to manage pregnancy with close antenatal surveillance was done. At 34 weeks 3 days of gestation, patient had spontaneous onset of labor with fetus papyraceous as the presenting twin, Hence A decision for lower segment caesarean section and a healthy female baby weighing 1.886 kgs with Apgar of 7 and 9 at 1 and 5 minutes respectively was delivered. A flattened parchment like fetus papyraceous was delivered along with placentae. Early diagnosis and appropriate monitoring are essential for favorable maternal and fetal outcomes.