TTTS is a severe complication characterized by an imbalance in blood flow between the donor and recipient twins and it affects 10% to 15% of MC twin pregnancies. This imbalance arises due to the presence of abnormal vascular connections in the shared placenta, leading to one twin (donor) having insufficient blood and the other (recipient) receiving excess blood. Consequently, the donor twin often experiences oligohydramnios and growth restrictions, while the recipient twin suffers from polyhydramnios and potential cardiac pathologies. The thesis explores the pathophysiology, diagnosis, and treatment of TTTS, highlighting the importance of early detection and intervention. The pathophysiology involves the presence of AV anastomoses, which are typically deep and unidirectional, creating a significant imbalance in blood flow between the twins. The presence of AA and VV anastomoses, which are more superficial and bidirectional, can mitigate this imbalance but are often scarce in TTTS cases. Early diagnosis through detailed ultrasound monitoring is crucial. Key markers such as polyhydramnios and oligohydramnios, identified through staging systems like the Quintero classification and others, are vital for the early detection of TTTS. These systems guide the intervention process and improve treatment outcomes. The preferred treatment, fetoscopic laser photocoagulation (FLPC), aims to ablate the connecting vessels to balance the blood flow. While FLPC has significantly improved outcomes, it carries risks, including the potential for complications such as preterm birth, cardiac, renal, and neurological impairments, as well as missed anastomoses. Despite advancements in diagnosis and treatment, TTTS remains a challenging condition. Ongoing research and refinement of management protocols are essential to improve long-term health outcomes for affected twins. This emphasizes the need for continuous advancements in therapeutic techniques and prenatal care strategies.