We have reported twin pregnancy complicated by uncommon "twin reversed arterial perfusion" syndrome. Ultrasound scan at 27th week of gestation revealed one normal foetus and the second one "acardiac" with severe malformations. Since the cardiac failure of the first twin was observed, the digitalis were administered till the end of pregnancy. The pregnancy was terminated at 31st week by caesarean section. We succeed in delivering one healthy newborn, which was possible by appropriate management including elective termination, observation (ultrasonography and cardiotocography) and nonsurgical intervention (digitalis).