Twin pregnancy complicated by fetus papyraceous: a case report

Ruby Bhatia; Manpreet Kaur; Himanshi Pareek; Mahak Singaal; Vidhushi Tewari

doi:10.18203/2320-1770.ijrcog20261647

Authors

Ruby Bhatia Department of Obstetrics and Gynaecology, MMIMSR, Ambala, Mullana, Haryana, India
Manpreet Kaur Department of Obstetrics and Gynaecology, MMIMSR, Ambala, Mullana, Haryana, India
Himanshi Pareek Department of Obstetrics and Gynaecology, MMIMSR, Ambala, Mullana, Haryana, India
Mahak Singaal Department of Obstetrics and Gynaecology, MMIMSR, Ambala, Mullana, Haryana, India
Vidhushi Tewari Department of Obstetrics and Gynaecology, MMIMSR, Ambala, Mullana, Haryana, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20261647

Keywords:

Twin pregnancy, Fetus papyraceous, Single fetal demise, Dichorionic diamniotic twins, High‑risk pregnancy

Abstract

Fetus papyraceous is a rare complication of multiple gestation resulting from intrauterine demise of one fetus during early or mid-pregnancy followed by compression by the growing co twin. We report a case of a 21-year-old primigravida with dichorionic diamniotic twin pregnancy complicated by intrauterine demise of one twin at approximately 17 weeks gestation. Serial ultrasonography revealed a macerated compressed fetus consistent with fetus papyraceous while the surviving twin continued to demonstrate normal growth parameters whereas fetus papyraceous was twin A and was the presenting fetus. A conservative approach to manage pregnancy with close antenatal surveillance was done. At 34 weeks 3 days of gestation, patient had spontaneous onset of labor with fetus papyraceous as the presenting twin, Hence A decision for lower segment caesarean section and a healthy female baby weighing 1.886 kgs with Apgar of 7 and 9 at 1 and 5 minutes respectively was delivered. A flattened parchment like fetus papyraceous was delivered along with placentae. Early diagnosis and appropriate monitoring are essential for favorable maternal and fetal outcomes.

References

Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics. 26th ed. New York: McGraw-Hill Education. 2022.

Woo HH, Sin SY, Tang LC. Single fetal death in twin pregnancies: review of maternal and neonatal outcomes and management. Am J Obstet Gynecol. 2000;182(2):444-9.

Pharoah POD, Adi Y. Consequences of in-utero death in a twin pregnancy. Lancet. 2000;355(9215):1597-602.

Khalil A, Rodgers M, Baschat A, Bhide A, Gratacós E, Hecher K, et al. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol. 2016;47(2):247-63.

Ong SSC, Zamora J, Khan KS, Kilby MD. Prognosis for the co-twin following single-twin death: systematic review. BJOG. 2006;113(9):992-8.

Hillman SC, Morris RK, Kilby MD. Co-twin prognosis after single fetal death: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2011;38(6):618-24.

D'Antonio F, Khalil A, Dias T, Thilaganathan B. Weight discordance and pregnancy outcome in twin pregnancy: systematic review. Acta Obstet Gynecol Scand. 2013;92(10):1076-84.

van den Boom J, Battin MR. Vanishing twin syndrome: review of literature and implications. J Paediatr Child Health. 2016;52:1048-53.

Lopriore E, Oepkes D. Fetal and neonatal outcome after demise of one twin. Best Pract Res Clin Obstet Gynaecol. 2008;22(1):159-73.

Royal College of Obstetricians and Gynaecologists. Management of Monochorionic Twin Pregnancy. Green-top Guideline No.51. London: RCOG; 2016. Available at: https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/management-of-monochorionic-twin-pregnancy-green-top-guideline-no-51/. Accessed on 26 April 2026.

American College of Obstetricians and Gynecologists. Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. ACOG Practice Bulletin No.231. Obstet Gynecol. 2021. Available at: https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2021/06/multifetal-gestations-twin-triplet-and-higher-order-multifetal-pregnancies. Accessed on 26 April 2026.

Khalil A, Sotiriadis A, Baschat A, Bhide A, Gratacós E, Raine-Fenning N, et al. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol. 2025;65:253-76.

ISUOG Practice Guidelines: Twin-to-Twin Transfusion Syndrome. Available at: https://www.isuog.org/clinical-resources/practice-guidelines.html. Accessed on 26 April 2026.

D’Antonio F, Khalil A. Twin reversed arterial perfusion sequence: current evidence and management. J Clin Med. 2024.

Khalil A, Bhide A, Gratacós E, Bhide A, Gratacos E, Hecher K, et al. ISUOG guidance on TRAP and TAPS. Ultrasound Obstet Gynecol. 2016;47(2):247-63.