Fetus papyraceous disguised as compound presentation: A case report.

Introduction: and importance: Fetus papyraceous (FP) is a rare condition that describes a mummified fetus in a multiple gestation pregnancy in which one fetus dies and becomes flattened between the membranes of the other fetus and uterine wall. Compound presentation occurs when the fetus's arm or leg is next to the main presenting part, very often the vertex is combined with arm presentation. A severe complication can occur in mother and child in such cases. Case presentation: We report a case of incidental finding of fetus papyraceous disguised as a compound presentation during normal delivery which was managed successfully without any complication. Discussion: Regular antenatal chorionicity assessment is essential for early diagnosis of fetus papyraceous and reduces mortality and morbidity in the surviving fetus. Conclusion: Early identification of such cases is necessary as it is associated with severe complications like preterm labor, infection from a retained fetus, severe puerperal hemorrhage, consumptive coagulopathy like disseminated intravascular coagulation, and obstruction by a low-lying fetus papyraceus producing dystocia leading to cesarean birth.

Pattern of Vaginal Birth after Cesarean, its Variables and Outcome at the Interval of One Decade in Dhulikhel Hospital.

BACKGROUND: There should be high index of suspicion for timely detection of any complications for safe trial of labor in case of vaginal birth after cesarean. Emergency obstetric care must be available. Even with these provisions the vaginal birth after cesarean rate is decreasing in Dhulikhel Hospital in recent years. METHODS: This retrospective study was conducted to compare different modes of delivery and pattern vaginal birth after cesarean in a gap of ten years in Dhulikhel Hospital (i.e. 2007 to 2009 versus 2017 to 2019). In this study factors associated with the successful vaginal birth after cesarean were also analyzed. RESULTS: A total of 4215 deliveries conducted in the year 2007 to 2009, of them 890 (21.1%) were cesarean deliveries. Likewise altogether 9298 deliveries conducted in the year 2017 to 2019, of them 2849 (30.6%) were cesarean deliveries. Vaginal birth after cesarean rate is significantly decreased from 18.33% (33/180) to 8.8% (63/713) (p value = 0.0004). Instrumental deliveries, normal vaginal deliveries were significantly decreased in comparison to these in the year 2007 to 2009. Duration of labor of vaginal birth after cesarean (7.05±1.25 vs 7.13±2.02, p=0.8362) and mean fetal weight of vaginal birth after cesarean baby (2818.71±686.37 vs 2820.79±511.78, p=0.9867) were not much different. CONCLUSIONS: Over the years, vaginal birth after cesarean rate is decreased.