Medical and Surgical Care

Medical care

Uncomplicated vanishing twin syndrome requires no special 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.^[36] 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.^{[37, 38]}

The provider should watch carefully for infection and consumptive coagulopathy.

Instruct pregnant women to seek medical care for vaginal bleeding, cramping, and pelvic pain.

The viable twin should receive specialized medical care as indicated by initial physical examination and subsequent mental and physical development.

Anand et al reported in 2007 that surviving cotwins had poorer scores on the Griffiths Mental and Development Scales when compared with singleton pregnancies.^[39]

Transfer

Evaluate pregnant women with vaginal bleeding at a site with adequate ultrasonographic capabilities.

Surgical care

Only perform dilation and curettage after ultrasonographic confirmation that a viable embryo or fetus does not exist.^[27]

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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 Treatment & Management

Medical and Surgical Care

Medical care

Transfer

Surgical care

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