Twin pregnancies generally represent a high-risk pregnancy. However, monozygous twins are real challenges for obstetricians due to the complications that may occur. Among the particular cases of monozygous twins in the University Emergency Hospital of Bucharest, Department of Obstetrics and Gynecology, a monochorial monoamniotic pregnancy with conjoined twins has been described. These particular medical circumstances require a deeper understanding of the vascular anatomical particularities. An accurate diagnosis implies a most detailed description of the morphological dynamics of the fetuses with the study of the impact of the vascular anomaly on their development so that the maximum chances of survival and the best outcome for the viable fetus can be obtained. The diagnosis of the most frequently associated anomalies is also extremely important.