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Grand Rounds

Vanishing Twin Following IVF and Risks for Adverse Pregnancy Outcomes

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BACKGROUND AND PURPOSE: 

  • Romanski et al. (Obstet Gynecol 2018) assessed the impact of a vanishing twin, following IVF, on perinatal and peripartum outcomes

METHODS: 

  • Retrospective cohort study
    • Vanishing twin following IVF  
    • Fresh or cryopreserved 
    • Day 3 to 5 transfer   
  • Patients with dichorionic-diamniotic twins were divided in to 3 groups  
    • Singleton  
    • Twins 
    • Vanishing twin 
  • Live birth defined as ≥24 wks  
  • Vanishing twin defined as  
    • 2 gestational sacs on ultrasound with demise of one twin ≤14 wks or 
    • No yolk sac or embryonic pole seen in one of the gestational sacs  
  • Primary outcomes  
    • Gestational age  
    • Birth weight at delivery 
  • Secondary outcomes were peripartum morbidities 
  • Subanalysis performed based on whether vanishing twin demise was identified before or after  fetal cardiac activity was noted

RESULTS: 

  • 1,189 pregnancies were included in the study 
    • 798 singleton 
    • 291 twins 
    • 100 vanishing twin 
  • Rate of vanishing twin was 25.6% of all twin pregnancies 
  • Mean gestational age at birth and birth weights were 
    • Singleton: 38.6±2.3 wks and 3,207±644 g  
    • Twins: 35.5±2.7 wks and 2,539±610 g  
    • Vanishing twin: 38.5±1.8 wks and 3,175±599 g  
  • Vanishing twin pregnancies, compared to twin pregnancies had lower odds of  
    • Preterm delivery: adjusted odds ratio (aOR) 0.12, 95% CI 0.07-0.22 
    • Small-for-gestational-age birth weight: aOR 0.14, 95% CI 0.07-0.28

CONCLUSION: 

  • For IVF pregnancies, vanishing twin outcomes for preterm birth and weight at birth were similar to those of singleton pregnancies  
  • Both vanishing twin and singleton had better outcomes than twin pregnancies

Learn More – Primary Sources: 

Perinatal and Peripartum Outcomes in Vanishing Twin Pregnancies Achieved by In Vitro Fertilization

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Related ObG Topics:

Vanishing Twin Pregnancy: Outcomes with IVF-ICSI vs Natural Conception
What Is the Best Follow-Up Diagnostic Test After a High-Risk NIPT Result?
What is the Actual Relative Risk of Preeclampsia in Twins Compared to Singletons?

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