'It was very upsetting': the pain of experiencing vanishing twin syndrome

Eugenie Pepper with children Tommy and Chloe.
Eugenie Pepper with children Tommy and Chloe. Photo: Supplied

When in her late 30s Randwick based hypnotherapist, Eugenie Pepper fell pregnant for the first time her scan revealed she was carrying twins, but a subsequent scan uncovered that one twin had vanished.

"My early scan showed the two babies were monoamniotic twins, sharing a placenta and amniotic sac," Ms Pepper says.

"They were actually so close together that my doctor thought they could be conjoined, which resulted in my natural conception pregnancy immediately being considered high risk."  

When a fortnight later and eight-weeks pregnant she returned to her GP for a second scan, it showed that the twins were not developing as they were supposed to. One twin was at the four-week mark and the other at the six-week mark.

"The GP suggested that it could be a case of vanishing twins, a concept I had never heard of before, and I was immediately referred to a high-risk specialist to investigate the growth of the twins," Ms Pepper says.   

When during the ultrasound that doctor said: I can see one very healthy baby, Ms Pepper immediately told him that she was expecting twins.

"He looked at me as if I was making it up," Ms Pepper recalls.

"I questioned him about the vanishing twin but his response, 'If there were two babies there before there is not now,' was very upsetting for me."

It became apparent at that stage that one of the twins had vanished.

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"I was trying to be strong about it and to clearly see the heartbeat of the remaining twin as reassuring," Ms Pepper says. 

"But I was really upset that he didn't take the time to look at the referral note before he spoke to me, which would have confirmed that I was indeed carrying multiples."

At the following visit Ms Pepper asked him about the vanishing twin again, and this time showed him her first scan that pictured the twins.

"His comment, 'I wasn't aware that you were having twins' followed by, 'If I had not seen the scan I wouldn't have believed it' was very upsetting as it reassured me that he thought I was making it up the first time," she says.

His words and attitude brought on great stress to Ms Pepper who asked for a referral to a counsellor that specialises in pregnancy loss and although the clinic promised to get back to her, they never did.

"Eventually I discovered that the Red Nose charity had a bereavement service and I just called them up because at that point the emotions were tricky to deal with and I needed support and someone to talk to," Ms Pepper says.

Ms Pepper remembers the feelings she felt as bittersweet.

"I was in shock and mourning a loss but at the same time I was excited to be pregnant," she says.

"I also focused all my attention on the way the news was delivered to me and that made it worse. There was no empathy by the doctor or in the way he handled the situation."

Unfortunately, by week 14 Ms Pepper miscarried the subsequent twin.

"I immediately began trying to conceive again and fortunately soon after I was pregnant with my son Tommy age 11 and the following year with my daughter Chloe age 10," she says.

"As a result of my previous pregnancy I did become a bit obsessed with reading medical studies, watching childbirth programmes and making sure I ate well."

To heal from her first pregnancy Ms Pepper did look into what might have been the reason behind vanishing twin syndrome but found no genetic link or explanation, so she just accepted it. In turn, she went on to study counselling to help other women through pregnancy loss.

"Looking back what I would have liked was to have received a list of counsellors from the clinic or a bereavement brochure to a charity for support," Ms Pepper says.     

"I think there should be a guideline to help medical carers handle these situations, to avoid upsetting patients. The point where we find that something is wrong is in that ultrasound office clinic and I don't think in my case they knew how to handle it." 

Dr Colin Walsh Obstetrician and Maternal-Fetal Medicine specialist, explains that vanishing twin syndrome is a condition whereby a pregnancy starts off as a twin pregnancy and one of the feutses is no longer visible on a later ultrasound. "The vanishing twin generally stops developing commonly within the first trimester and is absorbed back into the uterus, almost like an early miscarriage," Dr Walsh explained. 

Dr Walsh added that this is something that can occur with both natural pregnancies and IVF, but is more usual with fertility assisted pregnancies. "They are the ones where it's more likely the woman will have an early ultrasound around the six-or-seven-week mark, whereas spontaneous pregnancies don't require a scan so early on thus they never know they were carrying a twin," he says.

"In pregnancies where the twins are found to share a placenta and an amniotic sac (known as monochorionic-monoamniotic twins) or only a placenta (known as monochorionic-diamniotic twins) the latter estimated to be about 20 per cent of twin pregnancies, are both considered high-risk and should be monitored closely by a very experienced specialist as there is a chance of increased complications," Dr Walsh says.

"Thankfully, if vanishing twin syndrome does occur, and no subsequent miscarriage occurs the majority of surviving twins are delivered without additional complications."