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

3. 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.