Currently, there is no universally recognized treatment for vanishing twin syndrome (VTS). Treatment is most often not needed, especially when cases of VTS occur early in pregnancy and with dichorionic twins. In these instances, full resorption of deceased fetal remains is typically expected to occur before the end of the first trimester. In some cases, it may be necessary to remove deceased fetal remains from the womb to reduce risks for the surviving fetus(es) and pregnant individual, especially when losses occur later in pregnancy during the 2nd or 3rd trimester. 

The IVTSF encourages families to speak with their licensed healthcare providers about the most appropriate course of prenatal monitoring and treatment based on their individual circumstances and propensity for specific risks. 

Taking a look at how VTS pregnancies may be monitored...

There is conflicting evidence suggesting how VTS pregnancies should be monitored. This is largely due to a lack of consistent diagnostic terminology, guidelines, and early identification, especially in pregnancies conceived without reproductive assistance. Some evidence suggests that patients will experience little to no symptoms and do not require extra monitoring. Other sources suggest a range of possible symptoms and encourage additional scanning and prenatal appointments. Ultimately, every pregnancy is different, and individual circumstances can determine outcomes and the most appropriate course of action, so speaking with your provider about what is best for you is essential for optimizing care for you and your family.

The International Society for Ultrasound in Obstetrics and Gynaecology (ISUOG) suggests "that screening in twin pregnancies with a vanishing twin could potentially rely on a combination of maternal age, nuchal translucency (NT) measurement and serum free beta-human chorionic gonadotropin (b-hCG), as in a singleton pregnancy, without the use of serum PAPP-A, and that maternal serum PAPP-A level could be included on after appropriate adjustment for the interval between embryonic demise and blood sampling." (Khalil et al., 2025) Additionally, the American College of Obstetrics and Gynecology (ACOG), International Society for Prenatal Diagnosis (ISPD), and Society for Maternal Fetal Medicine (SMFM) recommend interpreting cfDNA results from prenatal testing following fetal demise with caution, as residual DNA from the deceased twin(s) may yield inaccurate or misleading data. The SMFM also provides coding guidance for healthcare professionals in cases of VTS.