Emergency Department Pre-Viability Delivery of a Fetus En Caul

En caul is a term used to describe the birth of a fetus and placenta entirely encased in an un-ruptured amniotic sac. Also colloquially referred to as a “mermaid” or “veiled” delivery, en caul births are uncommon in obstetrics literature and, therefore, exceedingly rare in the emergency department. Here, the author presents a case of a 34-year-old female with pre-viability delivery of a fetus en caul in the emergency department. Pre-viability delivery, regardless of membrane intactness, is associated with inevitable fetal loss. While emergency department physicians look for actionable practice guidelines, obstetric literature espouses expectant management, which consists of patient education and shared decision-making regarding patient comfort and goals of care. The author will discuss key diagnostic modalities and management steps for emergency department delivery of extremely premature infants.