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The occurrence of fetomaternal hemorrhage is very rare in singleton pregnancies and even rarer in multiple gestations. In monochorionic diamniotic twin pregnancies, shared placental circulation can amplify the consequences of fetomaternal hemorrhage, potentially resulting in more severe outcomes than in singleton pregnancies or in twins with double chorions and double amniotic sacs. A 39-year-old woman, natural conception, gravida 3, para 1, monochorionic diamniotic twins, refused to terminate the pregnancy at 36\u2009+\u20093 days. An emergency cesarean delivery was performed at 37\u2009+\u20093 weeks because of a sinusoidal fetal heart rate pattern, with a decision-to-delivery interval of 27\u2005min. Both neonates were born with severe neonatal asphyxia and anemia but demonstrated favorable recovery with resuscitation of neonatal asphyxia and transfusion therapy. 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