Placental Compromise and Severe Intrauterine Growth Restriction in the Surviving Co-Twin After Early Vanishing Twin Syndrome: A Case Report
DOI:
https://doi.org/10.68314/qf3yp140Keywords:
Vanishing Twin Syndrome, Fetal Growth Restriction, Intrauterine Growth Restriction, Multiple Gestation, Placental Insufficiency, Case ReportAbstract
Background: Vanishing Twin Syndrome (VTS)—the early spontaneous loss of one fetus in a multifetal gestation—occurs in up to 36% of twin pregnancies assisted by reproductive technology and approximately 10–15% of spontaneous twin pregnancies. While historically considered a benign event for the surviving co-twin, emerging evidence indicates that VTS can significantly impair residual placental function and fetal growth trajectories.
Case presentation: This report describes a primigravida who presented with early first-trimester ultrasound confirmation of a dichorionic-diamniotic (DCDA) twin pregnancy. Subsequent follow-up imaging demonstrated complete spontaneous reabsorption of one twin sac, indicating VTS. While antenatal monitoring continued as a single gestation, progressive fetal growth restriction (FGR) and altered umbilical artery (UA) Doppler indices were identified in the surviving fetus during the late second and third trimesters. Serial growth tracking and obstetric management resulted in the delivery of a very low birth weight (VLBW) infant at late term without major acute neonatal morbidities.
Conclusion: This case highlights that VTS should not be treated as a routine single gestation once twin disappearance is confirmed. Heightened biophysical and Doppler surveillance throughout the second and third trimesters is essential to detect latent FGR and optimize timing of delivery.
References
1. Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements—a prospective study. Am J Obstet Gynecol. 1985;151(3):333-7.
2. Magnus MC, Ghaderi S, Morken NH, Magnus P, Wilcox AJ, Skjaerven R, et al. Vanishing twin syndrome and risk of adverse perinatal outcomes in surviving co-twins: a national cohort study. Am J Obstet Gynecol. 2017;216(6):598.e1-11.
3. Zheng W, Zhang Y, Wang X, Liu C, Zhou J. Long-term perinatal and placental outcomes of surviving co-twins in vanishing twin syndrome: a systematic review and meta-analysis. Front Pediatr. 2022;10:891012.
4. Kiserud T, Piaggio G, Carroli G, Widmer M, Carvalho J, Neerup Jensen L, et al. The World Health Organization fetal growth charts: a multinational longitudinal study of fetal ultrasound biometry and estimated fetal weight. PLOS Med. 2017;14(1):e1002220.
5. Gordijn SJ, Beune IM, Thilaganathan B, Papageorghiou A, Baschat AA, Baker PN, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol. 2016;48(3):333-9.
6. Lees CC, Stampalija T, Baschat AA, da Silva Costa F, Ferrazzi E, Figueras F, et al. ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet Gynecol. 2020;56(2):298-312.
7. Alfirevic Z, Stampalija T, Medley N. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database Syst Rev. 2017;6(6):CD007529.
8. Sun L, Chen Z, Liu Y, Zhang J, Wang X, Zhao Y. Placental infarction and ischemia in surviving co-twins following first-trimester vanishing twin syndrome. Placenta. 2019;83:45-52.
9. Nardo LG, D'Anna R, Gullo G, Tripodi A. Placental bed vascular changes and fetal growth restriction following spontaneous early twin resorption. J Clin Med. 2024;13(4):1105.
10. Marton T, Wright C, Cox P, Weber MA, D'Sanny S, Heazell AE. Pathological examination of the placenta following first-trimester twin loss: diagnostic criteria and clinical implications. Histopathology. 2021;78(5):712-21.
11. Liu H, Xu Y, Zhao Y, Zhang L, Wang H. Early first-trimester vanishing twin and risk of late-onset placental insufficiency: a prospective cohort study. Placenta. 2023;135:22-9.
12. Salafia CM, Charles AK, Maas EM. Placental pathology in spontaneous early pregnancy loss and vanishing twin. Pediatr Dev Pathol. 2014;17(4):275-82.
13. Baschat AA. Planning delivery in fetal growth restriction with abnormal Doppler dynamics. Semin Perinatol. 2018;42(8):506-12.
14. Society for Maternal-Fetal Medicine (SMFM), Martins JG, Biggio JR, Abuhamad A. Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction. Am J Obstet Gynecol. 2020;223(4):B2-17.
15. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 227: Fetal growth restriction. Obstet Gynecol. 2021;137(2):e16-28.
16. Gratacós E, Figueras F, Hernandez-Andrade E, Nicolaides KH. Classification and management of fetal growth restriction based on stage of severity. Fetal Diagn Ther. 2021;48(11-12):781-93.
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