Fetal mummification complicating a dichorionic twin gestation: Clinical pearls for medical education

Abstract

Fetus papyraceous is a complication of multiple gestation characterized by single intrauterine fetal death of a twin, co-existing with a normal twin. It can present without problems to the mother and surviving twin but it increases the risk of death to the surviving twin, preterm delivery, dystocia, and other fetomaternal complications. This case aims to draw attention to the rare finding of a mummified twin coexisting with a normal twin, as well as the clinical management of such presentation. We present a case of a 32-year-old multigravida with no living children, who spontaneously conceived a twin pregnancy that was complicated by fetus papyraceous and eventual (inevitable) preterm delivery. The pregnancy was managed conservatively by frequent fetomaternal monitoring to allow for adequate fetal lung maturity. The surviving twin and mother remained stable postpartum. Frequent ultrasonographic monitoring along with conservative management to prolong pregnancy until fetal lung maturity is ascertained, are useful strategies in managing such a case, and the management of each case should be individualized. The following core competencies are addressed in this article: Medical knowledge, Patient care.