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

Matovelo D, Ndaboine E - J Med Case Rep (2015)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Catholic University of Health and Allied sciences, P.O. Box 1464, Mwanza, Tanzania. magonza77@yahoo.co.uk.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

The atrophied placenta tissues and mummified fetal bones
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Fig1: The atrophied placenta tissues and mummified fetal bones

Mentions: Upon admission to the labor ward, her vital signs were: blood pressure of 120/60mmHg, pulse rate 76 beats/minute and respiratory rate of 20 breaths/minute. An obstetrical examination revealed a gravid abdomen with fundal height corresponding to 36 weeks gestation and four strong uterine contractions in 10 minutes, each lasting 40 seconds. The fetal heart rate was auscultated to be 142 beats/minutes by fetoscope. On digital vaginal examination, the 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. The object was felt to be solid and sharp/pointed with some areas of softness. Due to lack of ultrasound and uncertainty of the presenting part together with arrested descent a decision was reached to deliver her by caesarean section. She was informed about the findings which she accepted and she consented to caesarean delivery. A caesarean delivery under spinal anesthesia revealed a twin gestation: 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 anterior to the lower segment at the level of the internal orifice of the uterus. The atrophied placenta and mummified fetal bones weighed 200gms. Our conclusion of diamniotic dichorionic twin with fetal papyraceus in the layers of placenta was reached (Fig. 1).Fig. 1


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

Matovelo D, Ndaboine E - J Med Case Rep (2015)

The atrophied placenta tissues and mummified fetal bones
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4549022&req=5

Fig1: The atrophied placenta tissues and mummified fetal bones
Mentions: Upon admission to the labor ward, her vital signs were: blood pressure of 120/60mmHg, pulse rate 76 beats/minute and respiratory rate of 20 breaths/minute. An obstetrical examination revealed a gravid abdomen with fundal height corresponding to 36 weeks gestation and four strong uterine contractions in 10 minutes, each lasting 40 seconds. The fetal heart rate was auscultated to be 142 beats/minutes by fetoscope. On digital vaginal examination, the 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. The object was felt to be solid and sharp/pointed with some areas of softness. Due to lack of ultrasound and uncertainty of the presenting part together with arrested descent a decision was reached to deliver her by caesarean section. She was informed about the findings which she accepted and she consented to caesarean delivery. A caesarean delivery under spinal anesthesia revealed a twin gestation: 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 anterior to the lower segment at the level of the internal orifice of the uterus. The atrophied placenta and mummified fetal bones weighed 200gms. Our conclusion of diamniotic dichorionic twin with fetal papyraceus in the layers of placenta was reached (Fig. 1).Fig. 1

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Catholic University of Health and Allied sciences, P.O. Box 1464, Mwanza, Tanzania. magonza77@yahoo.co.uk.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus