Diagnostic Considerations

Important considerations

Do not perform dilation and curettage until it is certain that no viable fetus remains.

If chorionic villus sampling is performed during a multifetal gestation, be aware that a mosaic placenta may be present. A viable fetus with normal chromosomes may be supported by the placenta of a vanished twin with abnormal chromosomes.^[27]

The full implications of fertility treatments that involve implantation of multiple eggs with reabsorption of several during the course of the pregnancy are unknown.^[28]

Special concerns

Parents who have experienced a loss from vanishing twin syndrome often must deal with the death of one child while caring for another who is preterm or may have serious medical complications. Little is written on the long-term effects on the family.^[29]One study examined parental attitudes on the psychological vulnerability of remaining singleton children after vanishing of a cotwin. This study found that, while parents perceived that these children had more motor difficulties, they thought of them as less vulnerable than controls.^[30]

Other problems to be considered

The following should also be considered in cases of suspected vanishing twin syndrome:

Threatened abortion
Decidual reaction on sonogram
Amniotic cavity observed on sonogram as a second fetus
Chorionic sac observed on sonogram as a second fetus
Yolk sac or extraembryonic coelom observed on sonogram as a second fetus
Subchorionic hemorrhage or hydropic change in chorionic villi observed on sonogram as a second fetus^[6]

Workup

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Sazonova A, Kallen K, Thurin-Kjellberg A, Wennerholm UB, Bergh C. Factors affecting obstetric outcome of singletons born after IVF. Hum Reprod. 2011 Oct. 26(10):2878-86. [QxMD MEDLINE Link].
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Author

Ann L Anderson-Berry, MD, PhD Associate Professor of Pediatrics, Section of Newborn Medicine, University of Nebraska Medical Center, Creighton University School of Medicine; Medical Director, NICU, Nebraska Medical Center

Ann L Anderson-Berry, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, Nebraska Medical Association, Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Terence Zach, MD Professor, Department Chair, Department of Pediatrics, Section of Newborn Medicine, Creighton University School of Medicine

Terence Zach, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Society of Reproductive Surgeons, American Society for Reproductive Medicine, Endocrine Society, Phi Beta Kappa

Disclosure: Received honoraria from Korea National Institute of Health and National Institute of Health (Bethesda, MD) for speaking and teaching; Received honoraria from Greater Toronto Area Reproductive Medicine Society (Toronto, ON, CA) for speaking and teaching; Received honoraria from American College of Obstetrics and Gynecologists (Washington, DC) for speaking and teaching; Received honoraria from National Institute of Child Health and Human Development Pediatric and Adolescent Gynecology Research Thi.

Chief Editor

Christine Isaacs, MD Associate Professor, Department of Obstetrics and Gynecology, Division Head, General Obstetrics and Gynecology, Medical Director of Midwifery Services, Virginia Commonwealth University School of Medicine

Christine Isaacs, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists

Disclosure: Nothing to disclose.

Vanishing Twin Syndrome Differential Diagnoses

Diagnostic Considerations

Important considerations

Special concerns

Other problems to be considered

References

Tables

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