The technique of ER utilizing interstitial laser is similar to that used in interrupting the blood supply of the acardiac twin in twin reversed arterial perfusion sequence [4–6] . In our cases of DCT pregnancies treated by intrafetal laser although all monochorionic co-twins were alive 1 h after the procedure half of these twins died within the subsequent 2 weeks. The most likely explanation for the deaths was retrograde haemorrhage into the placenta of the dead
fetus or the fetus itself if the occlusion of the fetal pelvic vessels was incomplete. In a total of 16 cases of twin reversed arterial perfusion sequence treated by intrafetal laser
at 12–20 (median 16) weeks’ gestation there was death of the pump twin within 2 weeks of the procedure in 5 (31%), which was attributed to incomplete vascular occlusion and haemorrhage into the dead acardiac twin [5, 6] .