Vanishing Twin Syndrome Signs Causes and Early Diagnosis

Pregnancy is a journey full of joy and expectations, but sometimes unexpected events occur, such as Vanishing Twin Syndrome (VTS), where one of the twins stops developing and is absorbed by the body. This condition is common during the early months of pregnancy and often causes anxiety for mothers, especially in multiple pregnancies. In this article, we will discuss the causes of Vanishing Twin Syndrome, its most common symptoms, accurate diagnostic methods, and its impact on the surviving twin, so you can understand all the essential information and take timely steps to protect the remaining pregnancy.

What is Vanishing Twin Syndrome (VTS)?
Vanishing Twin Syndrome is a condition in which one of the twins stops developing during pregnancy, and the mother’s body absorbs the non-developing fetus.
When does it usually occur?
It most commonly occurs during the early months of pregnancy, especially before week 12.
Sometimes it can happen later, but less frequently.
What causes it?

Genetic or chromosomal abnormalities in the lost fetus.
Problems with the placenta or blood flow.
Sometimes the cause is unknown and is not related to the mother’s health or lifestyle.

Are there any symptoms for the mother?

Occasionally, mild bleeding or slight cramps.
In most cases, there are no clear symptoms, and the mother may not realize she lost one of the twins until an ultrasound is done.

Does losing one twin affect the surviving twin?

In most cases, losing one twin does not affect the surviving fetus.
If the loss occurs after week 12, the surviving twin may require closer monitoring to ensure proper growth and health.

Can Vanishing Twin Syndrome be treated with medication or surgery?

There is no medication or surgery to restore the lost fetus.
The focus is on supporting the remaining pregnancy and monitoring the health of the mother and surviving twin.

How is it diagnosed?

Early pregnancy ultrasound can detect multiple fetuses.
Follow-up scans can show the stopped development and absorption of one fetus.

How to cope psychologically with the loss of a twin?

Feeling sadness, anxiety, or guilt after the loss is normal.
Psychological support is very important: consulting a therapist, sharing feelings with family, or joining support groups for mothers.

Will the next pregnancy be normal?

Yes, the next pregnancy is usually normal if standard health precautions are taken.

Tips for maintaining the health of the remaining pregnancy:

Regular prenatal check-ups and ultrasounds.
Healthy nutrition and prenatal supplements such as folic acid, iron, and calcium.
Adequate rest and sleep, avoiding smoking and alcohol.
Consult your doctor immediately if any unusual symptoms appear.

Additional Notes:

Vanishing Twin Syndrome is a type of miscarriage that occurs in multiple pregnancies, like twins or triplets. The fetus that stops developing is absorbed by the mother or the surviving twin(s), resulting in fewer children than initially expected.
Treatment is usually not required, but close monitoring may be needed if complications arise.
Emotional effects can be significant, so psychological support is recommended.
Risk reduction involves a healthy lifestyle, regular prenatal care, and managing any underlying health conditions.

When should you seek medical care during pregnancy?
Seek immediate medical attention if you experience any of the following:

Severe abdominal pain
Heavy bleeding
Signs of infection, such as fever

Long-term expectations:
Most women have positive outcomes, especially if the surviving twin is healthy.
Emotional support may be necessary to cope with feelings of loss.

What happens if the deceased twin is not absorbed?
In rare cases, the deceased twin may remain in the uterus as a thin layer containing parts like hair or teeth, which may appear as a teratoma tumor.
Usually, this does not cause any health problems for the surviving twin.

How common is Vanishing Twin Syndrome?
With advances in early pregnancy ultrasound, detection of this syndrome has increased.
The occurrence rate is estimated between 20% and 30% of multiple pregnancies.

What happens when one twin is absorbed by the other?
In Vanishing Twin Syndrome, the surviving twin and the mother’s body absorb the tissues of the non-developing twin.
This process is generally safe and does not harm the surviving twin or the mother in most cases.

How prevalent is Vanishing Twin Syndrome?
It is difficult to determine exact numbers, as many women lose a fetus before the first ultrasound.
Women who have early ultrasound are more likely to detect a vanished twin.
In IVF pregnancies, about 7% to 36% of multiple pregnancies are diagnosed with Vanishing Twin Syndrome.
Women over 30 years old are at higher risk for this syndrome.

How can you know if you have a vanished twin?
Often, it is not possible to detect a vanished twin before the first ultrasound.
In some cases, it may be discovered after birth by finding fetal tissue from the lost twin in the placenta.
Before ultrasound technology, the only way to detect a vanished twin was the presence of fetal tissue in the placenta.

Causes of Vanishing Twin Syndrome:
Vanishing Twin Syndrome usually occurs due to growth problems in one fetus or maternal-related factors, including:

Genetic problems in the fetus: Most cases are caused by chromosomal or genetic abnormalities in one fetus, which cannot continue developing and is absorbed by the body.
Placenta or umbilical cord issues: Any problem in nutrient delivery through the placenta can cause fetal loss. Poor blood flow may also halt fetal growth.
Uterine or maternal environment issues: Weak uterine walls, fibroids, or cysts can reduce the chances of fetal survival. Maternal stress or certain health conditions may play a minor role, but genetic causes are usually the main factor.
Multiple pregnancies: Carrying twins or more increases the likelihood of a vanished twin compared to a singleton pregnancy, especially in the first 12 weeks when small embryos are more vulnerable.
Maternal age: Older mothers are more likely to have genetic problems in the fetus, increasing the risk of Vanishing Twin Syndrome.

⚠️ Symptoms of Vanishing Twin Syndrome (VTS):

1. Early Pregnancy:

Often, no clear symptoms for the mother.
Sometimes mild bleeding or spotting may occur.
Mild cramps or slight abdominal discomfort.

2. During Ultrasound Follow-up:

Only one fetus appears instead of twins.
An empty gestational sac may be seen where the vanished twin was.
Occasionally, remnants of the lost twin may be visible in the uterus or absorbed by the body.

3. Effects on the Surviving Twin (rare):

Usually, there is no impact on the surviving twin’s health.
In very rare cases, growth problems or premature birth may occur if the twin vanishes after week 12.

Diagnosis of Vanishing Twin Syndrome:

Clinical Evaluation:
Diagnosis begins with a thorough evaluation by an obstetrician or midwife.

Medical history and physical examination help identify risk factors or signs of VTS.

Diagnostic Tests:

Ultrasound: The primary tool to confirm VTS. Detects one or more fetuses and assesses their growth.
Blood Tests: Measures pregnancy hormones, such as hCG, to monitor pregnancy health.
Genetic Testing: Sometimes recommended to check for chromosomal abnormalities in the surviving twin.

Differential Diagnosis:
Doctors may consider other conditions that mimic VTS symptoms:

Ectopic pregnancy: Often causes severe pain and bleeding.
Early miscarriage: Loss before 20 weeks may show similar symptoms.
Molar pregnancy: Abnormal tissue growth in the uterus causing complications.

Effects on Mother and Surviving Twin:

Impact on Mother and Fetus:

Loss in the first trimester usually has no symptoms for the mother or surviving twin; pregnancy outcomes are typically excellent.
If a twin dies in the second or third trimester, there are higher risks to the surviving twin, including cerebral palsy.
After fetal death, fluids and tissues are absorbed, flattening the deceased twin due to pressure from the surviving twin.
At birth, the deceased twin may appear compressed or flattened due to loss of fluid and soft tissues.

Possible Signs:

More common in women over 30.
Symptoms usually begin in the first trimester and may include:
- Mild bleeding
- Uterine cramps
- Pelvic pain

Recommended Medical Care After Vanishing Twin:

Pregnancy Follow-up:

Regular visits to the obstetrician to monitor the surviving twin’s growth and maternal health.
Monitor blood pressure and general pregnancy indicators.

Ultrasound:

Series of ultrasounds to follow the surviving twin, placenta, and umbilical cord.
Early scans confirm the surviving twin and detect any potential problems.

Monitoring Maternal Symptoms:

Track any bleeding, pain, or sudden changes during pregnancy.
Any unusual changes require immediate medical attention.

Nutritional Support:

Continue essential supplements: folic acid, iron, calcium, as advised by the doctor.
Maintain a healthy, balanced diet to support the surviving twin’s growth.

Psychological Support:

Losing a twin can be emotionally challenging.
Consult a psychologist or join support groups for pregnant women to cope with grief and anxiety.

Reducing Potential Pregnancy Risks:

Avoid smoking, alcohol, and unauthorized medications.
Maintain healthy weight and appropriate physical activity.

Birth Planning:

Your doctor will determine the optimal timing and method of delivery, especially if VTS occurs later in pregnancy.

Coping with Twin Loss:

1. Emotional Support:

Acknowledge your grief; it’s normal even if loss occurs in early pregnancy.
Talk with your partner, family, or trusted friends to relieve psychological stress.
Psychological counseling or support groups can help with coping and pregnancy-related fears.

2. Medical Follow-up:

Regular obstetric visits to ensure maternal and fetal well-being.
Routine ultrasounds to monitor growth and placental health.
Maintain a healthy diet and essential supplements for the surviving twin.

3. Social and Spiritual Support:

Join support groups to share experiences and reduce feelings of isolation.
Engage in calming activities such as walking, meditation, or breathing exercises.

4. Self-care:

Ensure adequate sleep and rest for a healthy pregnancy and emotional recovery.
Avoid stress as much as possible and maintain emotional stability.

5. Planning for the Surviving Pregnancy:

Set a birth plan with your doctor.
Be ready for regular pregnancy monitoring to ensure the surviving twin’s health.

Treatment of Vanishing Twin Syndrome:

1. Close Monitoring by Pregnancy Stage:

First Trimester (Weeks 1–12):
- If the twin vanishes early, usually no complications occur for the mother or surviving twin.
- Pregnancy generally continues normally with routine follow-up.
Second or Third Trimester (After Week 12):
- Later loss is considered higher risk, requiring close monitoring.
- There is an increased chance of preterm birth or health issues for the surviving twin.
- Doctors evaluate multiple factors to determine risk level and necessary interventions.

2. Medication:

No medication can restore the lost twin; VTS occurs naturally and cannot be reversed.

3. Supporting the Surviving Pregnancy:

Essential pregnancy supplements: folic acid, iron, calcium, vitamin D.
Medications may be prescribed to reduce cramps or bleeding if they occur.
Treat maternal health issues (e.g., high blood pressure, diabetes) that could affect pregnancy.

4. Continuous Medical Care: