FETAL DEMISE IN UTERO
  1. Specific sign
    • Absent cardiac motion (CRL = 5mm).
  2. Non specific signs
    • Development of dolichocephaly
    • "Spalding sign" - overlapping fetal skull bones.

 

Recent demise with early overlapping of the sutures

 

Chronic (old) demise with marked sutural overlap and anhydramnios

 

    • Epidermolysis: skin edema
    • Same or decreased BPD when compared to prior exam
    • Distorted fetus.
    • Abnormal angulation of the fetal spine due to collapse of the vertebral body.
    • Echogenic amniotic fluid due to fetal tissue fragments.
    • Gas in fetal vascular system

 

Fetal flexion

Gas in fetal vascular system

 

  1. Chronic demise – Fetus Papyraceus.
    • This is a term used to describe a flattened mummified fetus associated with a viable twin or multiple gestations. Intrauterine demise of a twin after 8 weeks of gestation results in mechanical compression of the small fetus such that it resembles parchment paper. Prior to 8 weeks, a fetal demise is usually resorbed and not visualized (1-5).
    • Usually embedded within the placenta membranes.
    • There may be complications to the mother or surviving twin. The surviving twin may have complications of twin embolization (e.g. aplasia cutis – localized absence of skin) (6,7).
    • A calcified fetus or lithopedion may occur if maturation is advanced. A lithopedion does not need to be a twin.

 

Chronic fetal demise

Acardiac twin of a monochorionic diamniotic

pregnancy (TRAP) syndrome

  • Spontaneous thrombosis of umbilical cord of acardiac twin.
  • Small, echogenic, compressed acardiac twin.

 

 

 

 

REFERENCES

 

  1. Jeanty P, Rodesch F, Struyven J: The vanishing twin. J Belge Radiol 1982;63: 526.
  2. Landy HJ, Deith L, Deith D. The vanishing twin. Acta Genet Med Gemellol (Roma)1982;31:179.
  3. Levi S: Ultrasonic assessment of the high rate of human multiple pregnancy in the first trimester. J C U 1976;4:3.
  4. Robinson HP, Caines JS: Sonar evidence of early pregnancy failure in patients with twin conceptions. Br J Obstet Gynaecol 1977;84: 22.
  5. Landy HJ, Weiner S, Corson SL,et al: The "vanishing twin": Ultrasonographic assessment of fetal disappearance in the first trimester. Am J Obstet Gynecol 1986;155:14.
  6. Wagner DS, Klein RI, Robinson HB et.al. Placental emboli from fetus papyraceous. J Pediatr Surg 1990;25(5):538-542.
  7. Visva-Lingam S, Jana A, Murray H et.al. Preterm premature rupture of membranes associated with aplasia cutis congenital and fetus papyraceous. Aust N Z J Obstet Gynaecol 1996;36(1):90-91.