Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 10 4 2026 04 18 142 146 Fateme Golshahi Department of Obstetrics and Gynecology, Maternal Fetal and Neonatal Research Center, Yas Hospital Complex, School of Medicine,Tehran University of Medical Sciences, Tehran, Iran. Nafise Saedi Department of Obstetrics and Gynecology, Maternal Fetal and Neonatal Research Center, Yas Hospital Complex, School of Medicine,Tehran University of Medical Sciences, Tehran, Iran. Behrokh Sahebdel Department of Obstetrics and Gynecology, Maternal Fetal and Neonatal Research Center, Yas Hospital Complex, School of Medicine,Tehran University of Medical Sciences, Tehran, Iran. Shirin Shamel Jahromi Department of Pediatrics, Yas Hospital Complex, School of Medicine,Tehran University of Medical Sciences, Tehran, Iran. Roksana Moeini Department of Neonatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Sima Amini Department of Obstetrics and Gynecology, Yas Hospital Complex, School of Medicine,Tehran University of Medical Sciences, Tehran, Iran. 2025 09 23 2025 11 18 We present a case of a primigravida woman at 30 weeks of gestation with monochorionic diamniotic (MCDA) twins, both affected by fetal growth restriction (FGR) and fetal anemia. One twin demonstrated absent end-diastolic flow on umbilical artery Doppler. Both twins had oligohydramnios. The placenta was enlarged (~110 mm in thickness) and showed gross clots at delivery, consistent with chronic placental abruption. Amniotic fluid was blood-stained during the cesarean section performed due to recurrent late decelerations. Placental pathology was normal except for mild vascular abnormalities. TORCH and antiphospholipid syndrome (APS) screenings were negative. This case highlights the diagnostic complexity of FGR and fetal anemia in both fetuses of MCDA twins and supports the chronic abruption-oligohydramnios sequence as the underlying cause. https://crcp.tums.ac.ir/index.php/crcp/article/view/1099 https://crcp.tums.ac.ir/index.php/crcp/article/download/1099/735