Losing One Twin and Carrying the Other

A loss that doesn’t end the pregnancy

My first pregnancy began as twins. Early on, I lost one while the other continued. This is what that was like, what I wish I’d had and what the research says about this kind of loss.

Miscarriages look different

A miscarriage can end a pregnancy. In a twin pregnancy, it can also happen while the pregnancy continues for months, as mine did. A loss can also come later, or at birth, and a loss at or after 20 weeks is called a stillbirth. People feel differently about each of them, and about the same kind of loss. This is one experience, mine. If yours looks like it, here’s what I learned.

What happened

I was about seven weeks pregnant when the bleeding started. My chart describes it as moderate at first, then “limited to dark spotting with wiping.” I wrote to my new specialist about pressure and period-like cramps every few hours, and a small amount of dried blood every day.

Eleven days later, I wrote again: “I’m noticing an increased amount of spotting over the past two days. It almost looks like small dots of red dead skin coming from my vagina. Is there anything that I should/should not be doing?”

The reply, two days later, in full: “Nothing to do. Let’s see today.”

They had seen two heartbeats and told me one baby was smaller than the other. At my second appointment with maternal-fetal medicine, the high-risk pregnancy specialists, I learned that I had lost one of my twins. It was a missed miscarriage, meaning the loss was found on the scan rather than passed by my body. The consultation note covers my genetic screening in detail. The loss gets one line: “Possible vanishing twin: reviewed no increased risk to the pregnancy.”

I sobbed outside the hospital building. Then I went to get pizza.

After that, I felt I had to steel myself to be happy for the baby I was still carrying. I didn’t want to talk about the loss for a really long time. It left me with fear and anxiety for the rest of the pregnancy.

What made it harder

I didn’t have any resources to deal with the grief.
I didn’t know if I should be grieving. I was still pregnant, and the loss was described as one line in a note.
My provider didn’t really acknowledge it. The visit moved on to screening.

It was a long time before I saw it acknowledged. Two years later, a doctor in a different specialty summarized my history in one line: my first pregnancy “was a twin gestation.” It was the first time I’d seen the loss acknowledged as part of my own history.

Key points

About 1 in 10 recognized pregnancies ends in miscarriage, and a vanished twin happens in an estimated 15% to 35% of twin pregnancies. If it happens to you, tell every new provider about the loss so it’s part of your history.
In one study of early pregnancy loss, 29% of respondents met screening criteria for posttraumatic stress and 24% reported moderate to severe anxiety one month later. That study was not specific to vanishing-twin loss, but it shows why asking for support matters. Ask for a mental health screening and support, even while the pregnancy continues.
A vanished twin can change which genetic screening tests are suitable for your pregnancy. Ask about screening limitations and diagnostic testing options before you test. The right approach depends on your pregnancy, the timing of the loss and the test being considered.

What the research says about this kind of loss

It usually happens early, often without symptoms. Vanishing twin syndrome usually happens in the first trimester, and most cases cause no symptoms. Some people have light bleeding, mild cramping or pelvic pain. A first-trimester loss usually doesn’t affect the surviving baby.

It can affect your screening. Losing one twin can affect prenatal screening. A DNA-based screening test may not be suitable, and another type of blood screening may be an option. But that test also has limitations. Ask your clinician or a genetic counselor which test makes sense for your pregnancy, when to take it, and whether you want to discuss diagnostic testing such as CVS or amniocentesis.

Grief while still pregnant is real, and often unrecognized. Researchers call grief that isn’t openly acknowledged or socially supported “disenfranchised grief.” Mothers who lost a twin described joy and grief at the same time, putting their emotions “on hold” and finding “At least you’ve still got one” deeply upsetting.

Acknowledgment is what women say they needed. In a study of women with a vanished twin, they wanted “acknowledgement of the vanished twin by the professional.” In a 2025 survey, vanishing-twin patients rated the information they got about 3.5 out of 10, and most wanted support groups or peer connection, then grief counseling.

The fear afterward has a name too. Pregnancy loss is linked to about twice the risk of depression, and a pregnancy after a loss is often more stressful because of the fear it will happen again. That matched my experience.

Where to find support

Postpartum Support International: online support groups for pregnancy and infant loss. HelpLine: 1-800-944-4773.
Share Pregnancy & Infant Loss Support: free online pregnancy loss groups, including one for pregnancy after loss. 1-800-821-6819.
Center for Loss in Multiple Birth (CLIMB): support for parents who have lost one or more babies from a multiple pregnancy.
Star Legacy Foundation, NY Metro: free virtual support groups and peer matching.
National Maternal Mental Health Hotline: call or text 1-833-TLC-MAMA, free and open 24/7.

Take this back

To discuss with your care team:

What does this ultrasound show, and what does it mean for this pregnancy?
Does the loss change my screening options, or how my results should be read?
Can you refer me to a counselor or a support group for pregnancy loss?

To discuss with the people in your life: Can you make room for both the grief and the hope, and talk about the loss with me when I’m ready?

What I do now

I name the loss with every new provider, and it’s in my own records, so I don’t depend on a chart to tell it for me.

Don’t wait if

Call your care team or go to triage for heavy bleeding, severe belly pain, fever, or dizziness or fainting in early pregnancy.

Next in the series: “Setting Up Your Care Structure”