A woman pregnant with twins had fetal ultrasounds as part of her standard obstetrical care. At 30 weeks gestation the estimated fetal weight (EFW) for Twin A was 1854 grams and for Twin B 1493 grams, yielding a 20% growth discrepancy. The patient's OB did not order closer surveillance. At 34 weeks an ultrasound revealed an EFW of 2706 grams for Twin A and 1385 grams for Twin B, a nearly 50% growth discrepancy. There was a clear discrepancy in the abdominal sizes. The OB informed the patient he believed the ultrasound findings were inaccurate, scheduling another scan in 10 days. The patient presented to the hospital for the ultrasound but before that the OB discovered Twin B had died. Both twins were delivered and Twin B had a cord wrapped around his neck. A medQuest radiologist specializing in ultrasound found negligent failure after the scan at 34 weeks to perform a biophysical profile, which would have included assessment of the amniotic fluid volume. Twin B's EFW decrease from 4 weeks earlier should have been alarming. The standard of care required an umbilical Doppler assessment. Lastly, the patient's radiologist failed to immediately alert the referring OB to initiate appropriate testing and close surveillance. A medQuest OB reported the patient's OB negligently failed to investigate the cause of the twin's growth discordancy at both 30 and 34 weeks. No fetal surveillance was begun at all. The baby's death was foreseeable and preventable. A medQuest maternal-fetal expert reported aggressive fetal monitoring should have been instituted. With appropriate care, a safe delivery of a healthy Twin B would have been performed.