Fetal transfusion syndrome is a serious complication of monozygotic multiple pregnancy and is associated with a high perinatal mortality rate. Recent literature has outlined aggressive interventions that attempt to improve the outcome of these pregnancies. We identified 25 cases of fetal transfusion syndrome from 595 multiple pregnancies delivered between January 1983 and December 1987 at the Grace Hospital. Analysis of antenatal factors with respect to survival showed that gestational age at delivery, the presence of hydrops, and the use of decompression amniocentesis may help in predicting outcome. These factors may be useful in deciding on the appropriate therapeutic approach for a particular pregnancy.