Twin Caesarean Delivery “En Caul” – A Case Report and Review of Literature

Abstract

Intact amniotic fluid membranes may serve to protect the extremely fragile preterm infant from some of the mechanical shearing forces caused by strong uterine contraction. A “caul” delivery occurs when part of the amniotic sac is still stuck to the neonate at the time of delivery, usually attached to the cephalic end or podalic end. An “en caul” delivery is a subtype of caul delivery, which occurs when the entire intact amnion (amniotic fluid sac) is delivered with the neonate inside.1,2 This article introduces the technique of “en caul” Caesarean delivery and reviews our experience. Abdominal (or Caesarean) en caul deliveries can be performed intentionally with surgical technique, on contrary to vaginal en caul deliveries, which occur spontaneously; as a result, vaginal en caul deliveries are considered to be rarer though exact statistics are difficult to determine. According to some estimates, caul deliveries would be 1 - 2 %, or roughly 1 in 80,000, of all vaginal deliveries if no membranes were artificially ruptured (ARM / Amniotomy).2,3 Most en caul births are low gravida, premature and low birth weight (LBW). Prematurity is a significant risk factor for various postpartum complications and is hazards. Previous case reports have poorly described pertinent maternal information beyond gestational age at birth (e.g., past medical history, past surgical history, familial history, and demographic data) which could be used to analyse additional risk factors for en caul birth.

Emergency Department Pre-Viability Delivery of a Fetus En Caul

“…En caul delivery, commonly referred to as “mermaid birth” or “veiled birth”, describes the delivery of an intact amnion. While en caul delivery is rare in obstetrics literature, occurring in less than 1 in 80,000 vaginal deliveries, it can be inferred that emergency department delivery of an en caul fetus is exceedingly rare [ 1 ]. Pre-viability delivery, regardless of membrane intactness, is associated with inevitable fetal loss [ 2 ].…”