Single fetal death in a twin pregnancy occurs in 5% of all twin pregnancies. Following single-twin death the perinatal mortality and the morbidity for the surviving twin is increased mainly in monochorionic pregnancy. These may include co twin death and survival impairment in the surviving co-twin in about 12% and 18% of cases respectively in case of monochorionic pregnancy and 4% and 1% in case of dichorionic pregnancy. The odds of intrauterine death of the co-twin and neurological abnormality among survivors is six and four times higher in monochorionic compared with dichorionic pregnancies due to shared placental circulation. The risk of preterm delivery is about 50% occurring 3 or 4 weeks after the death. No specific exam should be done in case of intrauterine death in dichorionic pregnancy whereas ultrasound and MRI should be realised to detect specific cerebral anomalies within 3-4 weeks of the death of the co-twin. For all death in utero occurring in twin pregnancy, a psychological care must be offered.