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

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.