Foot necrosis in a surviving fetus associated with twin-twin transfusion syndrome and monochorionic placenta.

Twin gestations with diamniotic monochorionic placentas have increased perinatal morbidity. We report a case in which, following the death of one member of a set of twins, absent end-diastolic flow was noted. At delivery, we noted thrombosis of placental vessels and vascular connections between the placental vessels of the larger and the smaller twins. The surviving twin was also noted to have necrosis of the right foot, consistent with a thromboembolic phenomenon.