eMedicine Specialties > Obstetrics and Gynecology > Obstetrical Complications

Vanishing Twin Syndrome: Treatment & Medication

Author: Ann L Anderson-Berry, MD, Assistant Professor of Pediatrics, Joint Division of Newborn Medicine, Creighton University, University of Nebraska Medical Center
Coauthor(s): Terence Zach, MD, Department Vice-Chair, Professor, Department of Pediatrics, Section of Newborn Medicine, Creighton University
Contributor Information and Disclosures

Updated: Sep 29, 2008

Treatment

Medical Care

  • If a fetus papyraceus remains, the pregnancy should be followed closely with serial ultrasonographic evaluation of the live fetus. Risks include premature labor, obstruction of labor, or death of the surviving fetus due to placental abruption or chorioamnionitis.20 This fetus is also at risk for low birth weight and small for gestational age (SGA) with increasing risk in the surviving twin for vanishing twin occurring later in gestation.21,22
  • The provider should watch carefully for infection and consumptive coagulopathy.
  • Uncomplicated vanishing twin syndrome requires no special medical care.

Surgical Care

Only perform dilation and curettage after ultrasonographic confirmation that a viable embryo or fetus does not exist.19

More on Vanishing Twin Syndrome

Overview: Vanishing Twin Syndrome
Differential Diagnoses & Workup: Vanishing Twin Syndrome
Treatment & Medication: Vanishing Twin Syndrome
Follow-up: Vanishing Twin Syndrome
References
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References

  1. Landy HJ, Weiner S, Corson SL, et al. The "vanishing twin": ultrasonographic assessment of fetal disappearance in the first trimester. Am J Obstet Gynecol. Jul 1986;155(1):14-9. [Medline].

  2. Saidi MH. First-trimester bleeding and the vanishing twin. A report of three cases. J Reprod Med. Oct 1988;33(10):831-4. [Medline].

  3. Sulak LE, Dodson MG. The vanishing twin: pathologic confirmation of an ultrasonographic phenomenon. Obstet Gynecol. Dec 1986;68(6):811-5. [Medline].

  4. Sampson A, de Crespigny LC. Vanishing twins: the frequency of spontaneous fetal reduction of a twin pregnancy. Ultrasound Obstet Gynecol. Mar 1 1992;2(2):107-9. [Medline].

  5. Landy HJ, Keith LG. The vanishing twin: a review. Hum Reprod Update. Mar-Apr 1998;4(2):177-83. [Medline].

  6. Yoshida K, Soma H. Outcome of the surviving cotwin of a fetus papyraceus or of a dead fetus. Acta Genet Med Gemellol (Roma). 1986;35(1-2):91-8. [Medline].

  7. Yoshida K, Matayoshi K. A study on prognosis of surviving cotwin. Acta Genet Med Gemellol (Roma). 1990;39(3):383-8. [Medline].

  8. Callen DF, Fernandez H, Hull YJ, Svigos JM, Chambers HM, Sutherland GR. A normal 46,XX infant with a 46,XX/69,XXY placenta: a major contribution to the placenta is from a resorbed twin. Prenat Diagn. Jul 1991;11(7):437-42. [Medline].

  9. Reddy KS, Petersen MB, Antonarakis SE, Blakemore KJ. The vanishing twin: an explanation for discordance between chorionic villus karyotype and fetal phenotype. Prenat Diagn. Sep 1991;11(9):679-84. [Medline].

  10. Lloveras E, Lecumberri JM, Pérez C, Melero C, Zamora L, Sánchez MA, et al. A female infant with a 46,XX/48,XY, +8, +10 karyotype in prenatal diagnosis: a 'vanishing twin' phenomenon?. Prenat Diagn. Oct 2001;21(10):896-7. [Medline].

  11. Verstraete L, Costa JM, Chantot-Bastaraud S, Siffroi JP, Fiori O, Uzan S. Finding a single XY cell among XX cells in amniotic fluid by FISH: a possible consequence of a vanishing male twin?. Prenat Diagn. Jan 2007;27(1):85-6. [Medline].

  12. Pharoah PO, Cooke RW. A hypothesis for the aetiology of spastic cerebral palsy--the vanishing twin. Dev Med Child Neurol. May 1997;39(5):292-6. [Medline].

  13. Classen DA. Aplasia cutis congenita associated with fetus papyraceous. Cutis. Aug 1999;64(2):104-6. [Medline].

  14. Jauniaux E, Elkazen N, Leroy F, et al. Clinical and morphologic aspects of the vanishing twin phenomenon. Obstet Gynecol. Oct 1988;72(4):577-81. [Medline].

  15. Chasen ST, Perni SC, Predanic M, Kalish RB, Chervenak FA. Does a "vanishing twin" affect first-trimester biochemistry in Down syndrome risk assessment?. Am J Obstet Gynecol. Jul 2006;195(1):236-9. [Medline].

  16. Abbas A, Johnson M, Bersinger N, Nicolaides K. Maternal alpha-fetoprotein levels in multiple pregnancies. Br J Obstet Gynaecol. Feb 1994;101(2):156-8. [Medline].

  17. Kelly MP, Molo MW, Maclin VM, Binor Z, Rawlins RG, Radwanska E. Human chorionic gonadotropin rise in normal and vanishing twin pregnancies. Fertil Steril. Aug 1991;56(2):221-4. [Medline].

  18. Blumenfeld Z, Dirnfeld M, Abramovici H, et al. Spontaneous fetal reduction in multiple gestations assessed by transvaginal ultrasound. Br J Obstet Gynaecol. Apr 1992;99(4):333-7. [Medline].

  19. Rudnicki M, Vejerslev LO, Junge J. The vanishing twin: morphologic and cytogenetic evaluation of an ultrasonographic phenomenon. Gynecol Obstet Invest. 1991;31(3):141-5. [Medline].

  20. Lau WC, Rogers MS. Fetus papyraceous: an unusual cause of obstructed labour. Eur J Obstet Gynecol Reprod Biol. Sep 1999;86(1):109-11. [Medline].

  21. Pinborg A, Lidegaard O, Freiesleben NC, Andersen AN. Vanishing twins: a predictor of small-for-gestational age in IVF singletons. Hum Reprod. Oct 2007;22(10):2707-14. [Medline].

  22. Shebl O, Ebner T, Sommergruber M, Sir A, Tews G. Birth weight is lower for survivors of the vanishing twin syndrome: a case-control study. Fertil Steril. Oct 9 2007;[Medline].

  23. Anand D, Platt MJ, Pharoah PO. Comparative development of surviving co-twins of vanishing twin conceptions, twins and singletons. Twin Res Hum Genet. Feb 2007;10(1):210-5. [Medline].

  24. Benirschke K. Intrauterine death of a twin: mechanisms, implications for surviving twin, and placental pathology. Semin Diagn Pathol. Aug 1993;10(3):222-31. [Medline].

  25. Anand D, Platt MJ, Pharoah PO. Vanishing twin: a possible cause of cerebral impairment. Twin Res Hum Genet. Feb 2007;10(1):202-9. [Medline].

  26. Pharoah PO. Prevalence and pathogenesis of congenital anomalies in cerebral palsy. Arch Dis Child Fetal Neonatal Ed. Nov 2007;92(6):F489-93. [Medline].

  27. Pinborg A, Lidegaard O, Andersen AN. The vanishing twin: a major determinant of infant outcome in IVF singleton births. Br J Hosp Med (Lond). Aug 2006;67(8):417-20. [Medline].

  28. Pinborg A. IVF/ICSI twin pregnancies: risks and prevention. Hum Reprod Update. Nov-Dec 2005;11(6):575-93. [Medline].

  29. Bryan E. Loss in higher multiple pregnancy and multifetal pregnancy reduction. Twin Res. Jun 2002;5(3):169-74. [Medline].

  30. De Pascalis L, Monti F, Agostini F, Fagandini P, La Sala GB, Blickstein I. Psychological vulnerability of Singleton children after the 'vanishing' of a co-twin following assisted reproduction. Twin Res Hum Genet. Feb 2008;11(1):93-8. [Medline].

  31. Pharoah PO. Neurological outcome in twins. Semin Neonatol. Jun 2002;7(3):223-30. [Medline].

  32. Pinborg A, Lidegaard O, la Cour Freiesleben N, Andersen AN. Consequences of vanishing twins in IVF/ICSI pregnancies. Hum Reprod. Oct 2005;20(10):2821-9. [Medline].

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Further Reading

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Keywords

vanishing twin syndrome, fetus papyraceus, mummified fetus, compressed fetus, cerebral palsy, cutis aplasia, complete reabsorption of fetus, formation of fetus papyraceus, placenta abnormalities, subchorionic fibrin, amorphous material, disappearance of a fetus, genetic abnormalities, chromosomal abnormalities, improper cord implantation, IVF, in vitro fertilization, assisted reproductive technology, ART

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Contributor Information and Disclosures

Author

Ann L Anderson-Berry, MD, Assistant Professor of Pediatrics, Joint Division of Newborn Medicine, Creighton University, University of Nebraska Medical Center
Ann L Anderson-Berry, MD is a member of the following medical societies: American Academy of Pediatrics and Nebraska Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Terence Zach, MD, Department Vice-Chair, Professor, Department of Pediatrics, Section of Newborn Medicine, Creighton University
Terence Zach, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Nebraska Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Andrea Witlin, DO, PhD, Former Assistant Professor, Department of Obstetrics and Gynecology, University of Texas Medical Branch
Andrea Witlin, DO, PhD is a member of the following medical societies: Society for Maternal-Fetal Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard S Legro, MD, Professor, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Pennsylvania State University College of Medicine; Consulting Staff, Milton S Hershey Medical Center
Richard S Legro, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Endocrine Society, Phi Beta Kappa, and Society of Reproductive Surgeons
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

David Chelmow, MD, Professor of Obstetrics and Gynecology, Tufts University School of Medicine; Program Director, Tufts University Affiliated Hospitals OB/GYN Residency Program; Chair, Tufts University Health Sciences Campus Institutional Review Board
David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making
Disclosure: Nothing to disclose.

 
 
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