Fetus papyraceus is a rare obstetric occurrence where one fetus in a multiple pregnancy experiences intrauterine death and subsequently becomes flattened, dehydrated, and parchment-like in appearance. This condition, sometimes referred to as fetus compressus, is most commonly observed in twin pregnancies, although it can occur in higher-order multiple gestations. While relatively uncommon, it is more frequently encountered in twin pregnancies.
Formation of a Mummified Fetus
The formation of a mummified fetus begins with the death of one fetus in a multiple gestation, typically during the late first or early second trimester, while the other fetus or fetuses continue to develop. Following fetal demise, the amniotic fluid surrounding the deceased fetus is gradually reabsorbed. As the surviving fetus grows and the uterus expands, the non-viable fetus is subjected to increasing mechanical compression from the uterine walls and the living twin’s amniotic sac. This sustained compression and dehydration lead to its characteristic “paper-like” or mummified appearance. The exact cause of fetal demise is often unknown, but it can be associated with factors such as unequal placental blood sharing, twin-to-twin transfusion syndrome (TTTS), chromosomal abnormalities, or umbilical cord issues.
Clinical Presentation
A mummified fetus often presents without distinct symptoms for the expectant mother. Its discovery is typically an incidental finding during a routine prenatal ultrasound examination, or even after childbirth during the examination of the placenta. While usually asymptomatic, some non-specific signs might rarely occur, such as mild vaginal bleeding in the first trimester or a discrepancy in uterine size compared to the expected gestational age. However, these signs are not definitive and can be associated with many other pregnancy conditions.
Diagnosis and Management
Diagnosis of a mummified fetus is primarily achieved through ultrasound imaging, which can visualize the compressed, non-viable fetus alongside the developing, healthy twin. Further diagnostic confirmation involves Doppler studies, demonstrating the absence of blood flow within the deceased fetus.
Once diagnosed, management depends on the health of the surviving twin. If the co-twin is healthy, active intervention for the mummified fetus is not required, and the pregnancy continues with careful monitoring of the viable fetus through serial ultrasounds. The mummified fetus is typically delivered alongside the viable infant(s) at term. While rare, potential complications for the surviving twin include growth restriction, cerebral palsy, or preterm labor, particularly in monochorionic pregnancies where twins share a placenta. Maternal complications are also infrequent but may include preeclampsia, disseminated intravascular coagulation (DIC), or labor dystocia, requiring careful maternal health monitoring.
Prognosis and Follow-up
The prognosis for the surviving twin in cases of fetus papyraceus is generally favorable with consistent prenatal monitoring throughout the pregnancy. After delivery, the mummified fetus typically does not pose a significant long-term health risk to the mother or affect future pregnancies. Emotional support can be offered to parents to help them process the unique circumstances of the pregnancy and delivery. The overall outcome for both the mother and the surviving child is usually positive with appropriate medical care and follow-up.