Bibhu Prasad Sahuabout 7 years ago

FETUS PAPYRACEOUS : (Rare case)

FETUS PAPYRACEOUS IS DEFINED AS A COMPRESSED, MUMMIFIED, PARCHMENT LIKE FETAL REMAINS OF A DEAD TWIN THAT IS RETAINED IN UTERO AFTER INTRA UTERINE DEATH IN THE SECOND TRIMESTER. Incidence of fetus papyraceous is 1 in 12,000 pregnancies and 1 in 200 youof twin pregnancies. The dead fetus is flattened between the membranes of the living fetus and the uterine wall. The surviving co twin is at risk of deveIopment of growth retardation, cerebrai encephalomalacia and microcephaly. The primary concern of fetus papyraceous is its effect on the surviving fetus and the mother. Once ,a diagnosis of fetus papyraceous is made, serial ultrasound examination and conservative management in the form of careful monitoring for better maternal and neonatal outcome is essential. If you find twins in early pregnancy scan and after few weeks ,if you couldn't find twins and there is only single pregnancy, it is known as VANISHING TWIN. There is no morbidity if one tein dies in utero in first trimester. COMPLICATIONS DURING DEATH OF ONE TWIN WITH A LIVE COSURVIVING TWIN : MATERNAL COMPLICATIONS ; 1) Preterm labour. 2) Infection from retained fetus. 3) Puerparal Hemorrhage. 4) Consumptive coagulopathy 5) Obstructed labour due to low lying fetus papyraceous causing dystocia leading to caesarean section. 6) Death of the surviving fetus due to placental abruption or chorio amnionitis. FETAL COMPLICATIONS ; 1) Cerebral palsy. 2) Aplasia cutis. 3) Microcephaly. 4) IUGR & IUD. The complications in fetus are attributed to the thrombi from the dead fetus embolising to the live twin and producing vascular occlusive lesions. The most common presenting complaints during pregnancy are bleeding, uterine cramps and pelvic pain. So , if a fetus papyraceous remains, the pregnancy should be followed closely by serial ultrasonographic evaluation ofthe live fetus. THE VIABLE TWIN SHOULD RECEIVE SPECIALISED MEDICAL CARE AS INDICATED BY INITIAL PHYSICAL EXAMINATION AND SUBSEQUENT MENTAL AND PHYSICAL DEVELOPMENT. IN MANY CASES OF FETUS PAPYRACEOUS ,THERE ARE NO COMPLICATIONS TO THE MOTHER OR TO THE SURVIVING TWIN. Here, I would like to share a case which I delivered 16 years ago. This patient is G4 P 3 L 3 . Scanning not done ( Scanning was done done routinely in those days. ) This patient had a normal delivery . After delivery, we could see a live twin and a mummified fetus papyraceous.