FOETUS PAPYRACEOUS A rare case presented by Dr

FOETUS PAPYRACEOUS (A rare case) presented by Dr Jagdish S Malpani M. D. , D. G. O. , F. C. P. S. Nashik Ob/Gy Society 22 August 2004 Monsoon Masti 1

INTRODUCTION Foetus papyraceous is a rare complication of Twin pregnancy in which death of one foetus occurs at mid-pregnancy, but the pregnancy continues thereafter. 22 August 2004 Monsoon Masti 2

CASE HISTORY • Renuka 20 yr Old Primigravida • C/O 8 mths amenorrhoea with preterm labour pains • Referred from Peripheral Hospital to JDC Bytco Municipal Hospital for ? Compound Presentation. • P 88/mt BP 130/80 Pallor Nil Oedema Nil CVS/RS NAD Rest NAD • PA- Ut 34 wks Vx Eng ROT FHS 126/mt Regular • PV- Cx 2 -3 Cm dil 40 -50% Eff. , PP Vx stn – 1, Small limb like structures felt in front of Vx, which were thin, irregular. INVESTIGATIONS Routine investigations were normal. Coagulation profile was normal. USG done 20 days ago showed Single iu pregnancy with AGA 32 wks, in Vx with mild oligoamnios 22 August 2004 Monsoon Masti 3

X-RAY Macerated Vertex Humerus Femur Spine 22 August 2004 Monsoon Masti 4

X- RAY Vertex Humerus Femur 22 August 2004 Monsoon Masti 5

MANAGEMENT • Low dose Pitocin was administered. • Inj. Drotin, Inj. Tramadol was given • Pt delivered vaginally with mummified Foetus Papyraceous delivering first with its macerated cord and placenta and normal Co-twin delivering by vertex Male 2. 250 Kg, • 3 rd stage of labour was uneventful. • Post partum period was uneventful • Pt was discharged on 5 th Day. 22 August 2004 Monsoon Masti 6

NORMAL CO-TWIN & FOETUS PAPYRACEOUS 22 August 2004 Monsoon Masti 7

FOETUS PAPYRACEOUS 22 August 2004 Monsoon Masti 8

DISCUSSION ü Incidence- 1: 184 of Twin pregnancies (. 54%) ü The amniotic fluid and sometimes the placental tissue may be reabsorbed, and the dead foetus is compressed between the amniotic sac of the co-twin and the uterine wall. ü Degree of compression depends upon the interval between death of the foetus and delivery. 22 August 2004 Monsoon Masti 9

REFERENCES 1. Livnat E J, Burd L, Cadken A, Keh P et al, Foetus Papyraceous in Twin Pregnancy; Obstetrics & Gynaecology 1978; 51 Suppl. 418458 2. Mills (1949), J. Obstetric &Gynaecology of British Empire, 56, 619 22 August 2004 Monsoon Masti 10

Thank you! 22 August 2004 Monsoon Masti 11