Selective fetal growth restriction (sFGR) is one of the main contributors to adverse outcomes in monochorionic and dichorionic twin pregnancies. This includes preterm birth, fetal demise, and long-term neurological impairment. While sFGR in dichorionic pregnancies is managed according to singleton pregnancies, no definite management strategy has yet been established for monochorionic twins complicated by sFGR. Options are expectant management, laser ablation of interfetal anastomoses, and selective cord coagulation of the sFGR twin. Given this uncertainty, it is essential to thoroughly explain the advantages and disadvantages of each approach to the parents-to-be and provide them with optimal support after they have made their decision.