The questions below are designed to help patients and families talk with their healthcare providers and understand what VTS may mean for them and their baby. These questions are based on current research that suggests a need for families and providers to know 1) chorionicity, 2) timing of death in gestation, if possible, and 3) cause of death/cessation of development in gestation, if possible. These 3 pieces of information can help determine potential risks for pregnant individuals and surviving children of VTS pregnancies, and may be helpful for navigating the health profiles of VTS survivors as they navigate their health profiles in the postnatal period, pediatrics, and into adulthood.

1. Pregnancy Details

• Was my pregnancy monochorionic (shared placenta) or dichorionic (separate placentas)?
  → Chorionicity affects how closely your babies shared blood flow. This can influence risks for the surviving twin or twins (in cases of higher-order pregnancies).

• At what stage of pregnancy did the loss occur, and why is the timing important?
  → Early losses are often absorbed without harm before 13 weeks gestation. Later losses may require additional monitoring.
  
  

2. Understanding the Loss

• Is it possible to know what caused the death of the twin(s) in utero?
  → Typically, the reason is unknown, but largely thought to occur as a result of chromosomal abnormalities. Ask your care provider if it is possible to discern the cause of death/cessation of development.

• Does this affect the health or development of the surviving twin(s)?
  → Your provider can explain any risks based on timing, chorionicity, your pregnancy history, and other factors (e.g., maternal age, etc.).
  
  

3. Monitoring & Testing

• How should my pregnancy be monitored going forward?
  → Ask about ultrasounds, lab tests, and checkups to ensure you and your baby(-ies) are safe.  The need for monitoring will vary from patient to patient, based on individual circumstances. Serial growth ultrasounds or antenatal testing (e.g., fetal heart rate tracings/non-stress tests or ultrasound assessments) may especially be recommended in the 3rd trimester.

• Could VTS affect prenatal screening like cfDNA/NIPT?
  → The presence of a vanished twin can sometimes cause confusing test results. Your provider may suggest repeating or confirming tests.
  
  

4. Risks & Care Plan

• What are the risks for me (bleeding, infection, placental issues)?
  → Your provider may be able to explain what to watch for. Symptoms will vary based on patient anatomy, timing of death in gestation, cause of death, and other factors.

• Are there special risks for my baby based on chorionicity and timing of loss?
  → Your provider may adjust your care plan if the loss happened later or in a shared placenta pregnancy. Monochorionic  pregnancies usually face the highest risks and require more extensive prenatal and postnatal care.

• Will this change my delivery plan?
  → In most cases, no, especially with VTS losses occurring in the first trimester—but in some situations, extra planning may be needed.

• How could the timing of my VTS case impact birth/death certificates at delivery, as well as the options for memorialization/disposition of any fetal remains that may be present at the time of delivery?

→ In most VTS cases, no fetal remains will be present at birth as full resorption typically happens by the end of the first trimester. Speak to your care provider about what you may be able to expect and what your options may be, given your individual circumstances.

5. Emotional & Supportive Care

• What resources are available for emotional support after a loss of multiples (i.e., twins, triplets, and higher-order)?
  → Many parents feel grief even while celebrating the surviving baby(-ies). Ask your provider what resources they may have available, or see our Resources and Partners page.

• Can you refer me or my loved ones to counseling or support groups?
  → If desired, consider asking for referrals to bereavement counselors, peer groups (e.g., for mothers, fathers, surrogates, etc.), or organizations focused on twin and multiple loss.