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Twin-Twin Transfusion Syndrome (TTTS) is a complication seen in monochorionic pregnancies due to unbalanced vascular anastomosis in placenta. It results in high perinatal mortality, thereby, warranting an early diagnosis. It has an incidence of 1-3 per 10,000 births. A case of TTTS is presented which was diagnosed on fetal ultrasound at 20 weeks of gestation. The donor twin had oligohydramnios with collapsed urinary bladder throughout the examination. The recipient twin had polyhydramnios, mitral as well as tricuspid regurgitation, pulmonary artery stenosis, high resistance flow in the umblical artery, reversal of A wave in ductus venosus and fetal ascites. To make the diagnosis of TTTS there should be a presence of monochorionic diamniotic pregnancy with polyhydramnios in the recipient twin and oligohydramnios in the donor twin.