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Case Report
Unexplained third-trimester intrauterine fetal demise after vanishing twin syndrome in a large for gestational age fetus: Possible association of subclinical and multifactorial hypercoagulability factors
1 Medical Student, DeBusk College of Osteopathic Medicine, 9737 Cogdill Rd, Knoxville, TN, USA
2 Obstetrician and Gynecologist, Tennova Women’s Health Specialists & Midwifery Services, Tennova North Knoxville Medical Center, Powell, TN, USA
Address correspondence to:
Benjamin Perdomo
2521 Irvin Chapel Way, Knoxville, TN 37931,
USA
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Article ID: 100225Z08BP2026
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Perdomo B, Soria J, Toney J. Unexplained third-trimester intrauterine fetal demise after vanishing twin syndrome in a large for gestational age fetus: Possible association of subclinical and multifactorial hypercoagulability factors. J Case Rep Images Obstet Gynecol 2026;12(1):18–21.ABSTRACT
Introduction: Diagnosing late intrauterine fetal demise (IUFD) can be challenging, especially with an otherwise uncomplicated pregnancy course. Identifying maternal risk factors and multifactorial thrombophilia patterns can be helpful to further understand its etiology and provide medical guidance for future pregnancies.
Case Report: A 31-year-old primigravida with a history of polycystic ovary syndrome (PCOS), obesity, and anemia conceived dichorionic-diamniotic twins with clomiphene. The patient had spontaneous early loss of Twin A at about eight weeks’ gestation, which was confirmed by ultrasound as vanishing twin syndrome. The surviving fetus (Twin B) demonstrated appropriate developmental growth and was large-for-gestational-age (LGA) through 33 weeks. At 34+4 weeks, the patient presented with decreased fetal movement, and IUFD was confirmed. Placental pathology and fetal karyotype were unremarkable, despite grossly abnormal placental architecture upon delivery. Two months postpartum, thrombophilia testing revealed a methylenetetrahydrofolate reductase (MTHFR) mutation, low protein S activity, and low PT/INR, highlighting the possibility of a subclinical thrombotic or microvascular process leading up to the fatal event.
Conclusion: This case demonstrates the potential significance of subclinical hypercoagulable or microvascular factors in an otherwise unexplained late IUFD, especially in patients with comorbid conditions such as PCOS, obesity, and vanishing twin syndrome. Consideration of earlier detection and individualized thrombophilia screening may be helpful in developing preventative approaches in similar high-risk pregnancies.
Keywords: Case report, Intrauterine fetal demise, Thrombophilia, Vanishing twin syndrome
SUPPORTING INFORMATION
Acknowledgments
We thank Nairmeen Awad Haller PhD, CHRC, the Corporate Senior Director for Research Operations of Community Health Systems for assistance and guidance in writing this case report.
Artificial intelligence (AI) use in the article
No artificial intelligence was used in the creation of this manuscript.
Author ContributionsBenjamin Perdomo - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Joslynn Soria - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Jeanette Toney - Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2026 Benjamin Perdomo et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
