Background: Acardiac twin syndrome is a rare entity complicating 1 in 100 monozygotic twin pregnancies and 1 in 35,000 births. It should be suspected in all monochorionic, malformed fetuses with cystic hygroma, generalized edema, and an absent cardiac pulsation with a nonfunctioning heart even at term. The higher the weight of the recipient twin, the more likely is the development of cardiac insufficiency and mortality in the pump twin. Case: A second gravida (G2P1) presented to the hospital in labor at term with 1 twin delivered at home by a dai (midwife) and referred to the authors when difficulty was encountered in delivery of the second twin. Fetal presentation could not be discerned and fetal heart sound was absent. The patient's cervix was fully dilated, membranes were absent, and the presenting part—buttocks with one foot—was felt high up. Urgent ultrasound revealed a grossly malformed fetus with absent fetal heart sounds, but a definitive diagnosis could not be established because of the absence of liquid. Under general anesthesia, a breech extraction was tried but failed because of the short limbs of the undelivered twin. With a tentative diagnosis of acardiac twin, this destructive procedure was abandoned and a laprotomy was performed. The fetus was delivered in a breech position with difficulty. This twin was an acardiac acephalus, severely hydropic fetus weighing 4.5 kg. This twin could never have been delivered by any destructive procedure. Conclusions: Acardiac twin at term gestation without any complication is generally unknown. However, in this case, the acardiac twin was almost double the size of the pump twin; yet, the pump twin had a normal perinatal outcome. Thus, keeping in mind the possibility of an acardiac twin being present even at term can save the mother from unnecessary attempts to extract such a twin using destructive procedures and prevent their consequences. (J GYNECOL SURG 26:275)