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CASE SNIPPET
Year : 2019  |  Volume : 65  |  Issue : 2  |  Page : 119-120

Incidentally diagnosed fetus compressus on placental examination


Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Web Publication26-Apr-2019

Correspondence Address:
P Pradhan
Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpgm.JPGM_400_18

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How to cite this article:
Chikhale M V, Pradhan P. Incidentally diagnosed fetus compressus on placental examination. J Postgrad Med 2019;65:119-20

How to cite this URL:
Chikhale M V, Pradhan P. Incidentally diagnosed fetus compressus on placental examination. J Postgrad Med [serial online] 2019 [cited 2019 May 20];65:119-20. Available from: http://www.jpgmonline.com/text.asp?2019/65/2/119/253730




The frequency of twin gestation has increased due to increased incidence of use of artificial reproductive techniques.[1] Studies have shown that mothers with twin pregnancy and chronic diseases like gestational diabetes have a tendency to absorb one out of the two embryos.[2] Most of these cases are diagnosed based on ultrasonography. Here, we present an unusual case, where a fetus compressus was incidentally diagnosed in a vanishing twin syndrome following spontaneous conception.

A 28-year-old second gravida having gestational diabetes mellitus (GDM) with one live tissue delivered a healthy term baby which was a spontaneous conception having unremarkable ultrasonography findings in the antenatal period. She went into spontaneous labor at 38 weeks and had an uneventful normal vaginal delivery followed by an event-free postpartum phase for mother and baby. The birth weight of the baby was 3.2 kg and it cried immediately after birth. No congenital anomalies were noted. The placenta was sent for examination in view of GDM in the mother. On gross examination, the placenta weighed 200 g and measured 17 × 15 × 3.5 cm. The attached cord measured 10 cm and showed three vessels on transverse section. There were normal-appearing amniotic and chorionic membranes. Serial slices of the placenta showed a congested cut surface with no calcification or loss of nodularity. One edge of the placenta showed a whitish nodule [Figure 1]. Detailed dissection revealed a partially cut-open well-defined cavity measuring 10 × 4 × 4 cm lined by distinct amniotic and chorionic membranes, within which a compressed fetus attached by a shrunken fibrotic cord was identified. The fetus along with the fibrotic cord measured 8 × 3 × 2.2 cm and weighed 28.4 g. The fetus length measured 4.8 cm. It had an identifiable head with optic placode and fore limbs. The fore limbs were only mildly elongated limb buds. Hands and fingers were not formed. Lower limb buds were imperceptibly blended and compressed with the cord structures forming a band-like adherent tissue [Figure 2]. These features corresponded to a fetal age between 4 and 8 weeks. Histologic examination of the placenta showed findings consistent with term maturity. No pathological changes were noted. A diagnosis of fetus compressus with vanishing twin syndrome in dichorionic diamniotic twins was made. On follow-up, the mother and live baby were healthy when discharged.
Figure 1: Placenta with attached membranes and cord (green arrow) and rudimentary fetus compressus (yellow arrow)

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Figure 2: Fetus compressus having head (red arrow), identifiable limb buds (blue arrow), and fibrotic cord (green arrow)

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Loss of a twin very early in the pregnancy shows only ultrasonographically and histologically detectable amorphous material, which is called fetus evanescence. Fetus compressus, unlike fetus papyraceous, shows the flattening of the just-born twin, due to pressure effects, but it is not incorporated within the membranes or placenta of the live born twin due to inadequate time.[3] Though such cases have been reported before, this report is unusual owing to its incidental detection during gross examination of placenta and is likely to be a possible sequelae of the gestational diabetes. Although unsuspected, even in the antenatal ultrasound and intrapartum, this case emphasizes the importance of meticulous examination of all placentas after delivery.

Declaration of patient consent

The authors certify that appropriate patient consent was obtained.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 :: References Top

1.
Pinborg A, Lidegaard O, la Cour Freiesleben N, Andersen AN. Consequences of vanishing twins in IVF/ICSI pregnancies. Hum Reprod 2005;20:2821-9.  Back to cited text no. 1
    
2.
Márton V, Zádori J, Kozinszky Z, Keresztúri A. Prevalences and pregnancy outcome of vanishing twin pregnancies achieved by in vitro fertilization versus natural conception. Fertil Steril 2016;106:1399-406.  Back to cited text no. 2
    
3.
Daw EG. Fetus vanescens, fetus compressus and fetus papyraceus. J Obstet Gynaecol 1992;12:375-6.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
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