Demise of a twin

Last revised by Dr Jeremy Jones on 20 Sep 2021

Demise of a twin is a complication that can occur in a twin pregnancy (particularly monochorionic pregnancies) and may be due to a wide range of conditions. Once the twin dies, most of the dead twin tends to be absorbed leaving behind a small flattened remnant known as the fetus papyraceus.

The incidence of intrauterine death of a single twin is ~6.5% (range 6-7%) 1-2.

Twin (or other multifetal) pregnancy with one twin having an absent heartbeat, and often being smaller than the live fetus, with oligohydramnios.

In some cases, only one fetus may be identified on ultrasound of a previously documented twin pregnancy 5, and this may be due to resorption or miscarriage of the demised twin, the so-called vanishing twin syndrome.

  • twin embolization syndrome: the surviving healthy fetus in a monochorionic co-twin demise
  • surviving co-twin is at risk of development of growth restriction, cerebral encephalomalacia, and microcephaly

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Cases and figures

  • Case 1
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  • Case 2: vanishing twin syndrome
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