Case notes

A 35-year-old woman, G1P0000, was pregnant with monochorionic diamniotic twins conceived through in vitro fertilization. Initially, the patient experienced an uncomplicated prenatal course, but at 28 weeks’ gestation, she presented to the hospital with spontaneous premature ruptured membranes. Her labor progressed, and she underwent a primary elective cesarean section. Twin A was delivered from the cephalic presentation. Twin B, delivered from the breech position, was born en caul, that is, the infant was encased in the intact amniotic sac ( Figure ). The infant weighted 2 lb, 8 oz. All 3 patients did well.

The infant was born en caul, still enclosed within the unbroken amniotic sac.

Prabakar. Perfectly packaged. Am J Obstet Gynecol 2012.

Conclusions

En caul birth is a rare event, occurring only once in every 80,000 live births. However, these births likely occur with a much higher frequency than has been documented. This event is typically observed in premature births because the amniotic sac balloons out as the fetus is being delivered. In so-called caul births, only a portion of the amniotic sac covers the head or face of the fetus.

Beliefs surrounding en caul births can be traced to medieval folklore, including the perception that they signify great luck and fortune. A social history of such deliveries describes numerous examples of caul-related superstitions recorded throughout history. More recently, studies have shown a protective effect of en caul vaginal deliveries in extremely preterm breech infants. In addition, delivering the preterm second twin within the intact amniotic sac provided an atraumatic environment for the infant.