Acute intrapartum fetal hemorrhage of both twins through monochorionic placenta and a velamentous cord

Twin-to-twin transfusion syndrome is a well described chronic complication associated with monochorionic twin gestation. Acute fetoplacental transfusion after birth of the first twin has infrequently been described. We present a case of acute intrapartum fetal hemorrhage associated with an avulsed velamentous insertion of the first twin's cord and twin-to-twin transfusion. Acute fetoplacental transfusion of fetoplacental hemorrhage is a risk to the second twin in monochorionic gestations. However, when this coexists with a velamentous cord insertion, both fetuses are at risk for intrapartum hemorrhage.