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

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.

Partial annular cervical tear: A case report

BACKGROUND

Intrapartum annular cervical tears are a rare pregnancy complication. The mechanisms underpinning these tears remain to be elucidated and currently the optimal management and future pregnancy implications remain unknown.

CASE PRESENTATION

We present the case of a 35-year-old nulliparous woman who was diagnosed with a partial annular cervical tear following induction of labour. Her intrapartum course was also complicated by an intrapartum fever, prolonged labour induction and an antepartum haemorrhage. During the second stage of labour, a band of cervical tissue could be seen at the introitus and abutting the fetal head. Following normal vaginal delivery, a portion of cervical tissue was visualised, 2 cm thick by 5 cm long, avulsed at the lateral edge at 9 o'clock and extending in an annular anti-clockwise fashion towards 1 o'clock. She underwent surgical repair of the cervical tear and had an uneventful postnatal course. At 6 weeks post-partum her cervix appeared to be healing well with 2 cm length palpable on vaginal examination.

CONCLUSION

To the best of our knowledge, this case is the first report of a partial annular cervical tear to present in this manner. While the optimal management and outcomes for tears of this nature remain unknown, we recommend prenatal ultrasound cervical length screening with consideration of a cervical cerclage and elective caesarean section, which could avoid pre-term birth or the recurrence of this type of tear in future pregnancies.

Defining intertwin birth weight discordance and optimal delivery time in dichorionic twins: a retrospective cohort study

BACKGROUND

A high birth weight discordance (BWD) places twins at high risks of adverse perinatal outcomes; however, there is no commonly accepted definition of intertwin BWD. Given that gestational age (GA) is closely associated with both BWD and adverse neonatal outcomes, the aim of our study is to develop a measure that takes both BWD and GA into account to define BWD and explore the potentially optimal delivery time in dichorionic twins, with the balance against the risk of intrauterine demise and adverse neonatal outcomes.

METHODS

About 99,000 mixed gender twin pairs from the US matched multiple birth file from 1995 to 2000 were enrolled in our study. We set up a two-dimensional matrix model to select the BWD cutoff point related to outcomes. The optimal delivery time was identified based on the risks of adverse neonatal outcomes and fetal death by GA.

RESULTS

The combination of BWD and GA had a higher predictive performance for adverse neonatal outcomes than BWD alone (area under ROC curve (AUC): 0.816 vs. 0.523, p < .001). When GA was controlled for, the growth discordant cutoff point was BWD at the 40% level. The optimal delivery time suggested in dichorionic twins with BWD higher than 40% was identified at 33-34 gestational weeks.

CONCLUSIONS

The combination of BWD and GA was a better predictor for adverse neonatal outcomes than BWD alone. In dichorionic twins with BWD >40%, pregnancy may be continued till 33-34 gestation weeks if there is no indication for immediate delivery.