Fetus papyraceus causing dystocia: inability to detect blighted twin antenatally

A case is reported of fetus papyraceus diagnosed intrapartum. There was no clinical evidence in early and midpregnancy to suggest such a diagnosis. Ultrasound examination performed 1 week prior to delivery was nondiagnostic, but an x-ray taken intrapartum revealed dystocia caused by fetus papyraceus, thus necessitating cesarean section. It is suggested that the clinician consider x-ray as well as ultrasound in the diagnosis of fetus papyraceus. In addition to the obstetric morbidity, there is considerable neonatal morbidity which further increases the importance of antenatal diagnosis of fetus papyraceus.