Addressing Patient-Provider Communication Gaps in Vanishing Twin Syndrome: Implications for Patient Care and Clinical Guidelines

Introduction: Vanishing twin syndrome (VTS) refers to the in utero demise of one or more fetuses in a multiple pregnancy, often with physical remains persisting throughout gestation or at birth. Despite increased detection via early ultrasound and due to the use of ART, clinical protocols for VTS remain inadequate. This systematic review assesses physical and psychological risks, the current state of patient-provider communication, and international guideline gaps in VTS care. Materials & Methods: A systematic literature review was conducted using key search terms including but not limited to “vanishing twin* syndrome,” “patient-provider communicat*,” and “bereave* care.” Studies were selected based on relevance to patient experiences, international clinical guidelines, and the physical and psychological impacts of vanishing twin syndrome. Results: Patients with vanishing twin syndrome report inconsistent disclosure, inadequate emotional support, and confusion regarding the management of fetal remains. Physical risks to surviving multiples include low birth weight, placental pathology, and neurodevelopmental concerns. Maternal serum screening and cfDNA results are often confounded due to lingering fetal DNA or hormones from the demised fetus(es). These complications are underreported and poorly explained in current research and clinical guidances. Conclusions: Improved vanishing twin syndrome management requires early chorionicity assessment, updated screening protocols, and training on compassionate disclosure. Evidence-based guidelines should account for screening artifacts, placental sequelae, and bereavement care. Future studies must stratify outcomes by gestational age at loss, chorionicity, and ART exposure to clarify risks and optimize care.