Fetal Papyraceus Discovered at Second Stage of Labour in an Unbooked Patient: A Case Report

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P. A. Awoyesuku


Background: Fetus Papyraceus is a rare condition with the intrauterine death and subsequent retention of one or more fetuses of a multiple gestation. Antepartum diagnosis of fetus papyraceus is infrequent and usually it is a chance finding during investigation of some other pregnancy problem on ultrasonography. I report a case of fetus papyraceus in an unbooked patient diagnosed at second stage of labour.

Case Presentation: A 26-year-old, unbooked primigravida, presented to the Labour Ward at a gestational age of 35 weeks with painful uterine contractions of 6 hours duration. On admission, she had features of mild pre-eclampsia, but had good contractions and was in established labour. She had an obese anterior abdominal wall with marked oedema, which made discerning the fetal presentation and auscultating the fetal heart sounds difficult. She was however delivered of a live baby weighing 3300 g with Apgar scores of 8 in one minute and 10 in 5 minutes. This was followed by the delivery of a fetus papyraceus weighing 200 g, with crown rump length of 85mm. subsequent delivery and examination of the placenta revealed a diamniotic-monochorionic twin gestation. Both the mother and live baby were discharged home in good condition.

Conclusion: The antenatal diagnosis of fetus papyraceus is usually a chance finding on obstetric scan for other problems or routinely. The primary concern for fetus papyraceus is its effect on the surviving fetus. Regular antenatal care and routine ultrasonography in pregnancy is mandatory to diagnose and manage possible complications. However, this patient did not enjoy such benefits. Where this is missed, routine placental examination to search for fetus papyraceus and establish chorionicity is mandatory.

Twin pregnancy, intrauterine death, fetus papyraceus.

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How to Cite
Awoyesuku, P. A. (2019). Fetal Papyraceus Discovered at Second Stage of Labour in an Unbooked Patient: A Case Report. Asian Journal of Case Reports in Medicine and Health, 2(2), 1-5. Retrieved from https://journalajcrmh.com/index.php/AJCRMH/article/view/30104
Case Report


Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacher F, Kirmeyer S. Births: Final data for 2004. National Vital Statistics Report. Center for Disease Control and Prevention; Atlanta, GA. 2005; 55:1.

The American College of Obstetricians and Gynecologists. Multiple gestation: complicated twin, triplets and higher-order multifetal pregnancy. ACOG Practice Bulletin number 56. ACOG, Washington DC; 2004.

Dickey RP, Taylor S, Lu PY, Sartor BM, Storment JM, Rye PH, et al. Spontaneous reduction of multiple pregnancy: Incidence and effect on outcome. Am J Obstet Gynecol. 2002;186(1):77-83.

Rathi BA, Rathi S. Fetus papyraceus – A case report. J Obstet Gynaecol India. 2003;53:188.

Woo HH, Sin S, Tang IC. Single fetal death in twin pregnancies: review of the maternal and neonatal outcomes and management. Hong Kong Med J. 2000;6(3):293-300.

Dahiya P, Ranjita B. Conservative management of fetus papyraceus: A report of two cases. Oman Med J. 2014;29(2): 132-4.

Saier F, Burden L, Cavanagh D. Fetus papyraceus: An unusual case with congenital anomaly of the surviving fetus. Obstetrics and Gynecology N.Y. 1975;45: 217.

Matovelo D, Ndaboine E. Fetus papyraceus causing dystocia in a rural setting: A case report. Journal of Medical Case Reports. 2015;9(1):178.

Daw E. Fetus papyraceus – 11 cases. Postgrad Med J. 1983;59(695):598-600.

Matovelo D, Ndaboine E. Fetus papyraceus causing dystocia in a rural setting: a case report. Journal of Medical Case Reports. 2015;9:178.

Landy HJ, Keith I. The vanishing twin: a review. Hum Reprod Update. 1998;4(2): 177-83.

Benirschke K. Intrauterine death of a twin: Mechanisms, implications for surviving twin and placental pathology. Semin Diagn Pathol. 1993;10(3):222-31.

Fusi I, Gordon H. Twin pregnancy complicated by single intrauterine death: problems and outcome with conservative management. Br J Obstet Gynaecol. 1990; 97(6):511-16.

Classen D. Aplasia cutis congenita associated with fetus papyraceus. Cutis. 1999;64(2):104-6.

Anand D, Platt M, Pharaoh P. Vanishing twin: A possible cause of cerebral impairment. Twin Res Hum Genet. 2007; 10(1):202-9.

Pharaoh P. Prevalence and pathogenesis of congenital anomalies in cerebral palsy. Arch Dis Child Fetal Neonatal Ed. 2007; 92(6):F489-93.