Donepudi R, Espinoza J, Nassr AA, et al. - Given the correlation of selective fetal growth restriction (sFGR) complicating twin to twin transfusion syndrome (TTTS) with 3 to 6 fold elevated risk of fetal demise after fetoscopic laser surgery (FLS), researchers here examined the correlation of of three currently used definitions for sFGR with demise of the smaller twin, typically the donor, following FLS. Between January 2015 and December 2018, 124 patients underwent FLS for TTTS. Classification of the entire cohort was performed as sFGR and non sFGR employing 3 different criteria: 1‐ International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) as estimated fetal weight (EFW) of either twin < 10th centile and the intertwin discordance > 25% (Group A); 2‐ Delphi methods, EFW of either twin < 3rd centile (Group B); 3 – Delphi method, presence of 2 of the 4 criteria: EFW of either twin < 10th centile, abdominal circumference of one twin < 10th centile, EFW discordance of ≥ 25%, and umbilical artery pulsatility index of smaller twin > 95th centile (Group C). A significantly higher rate of post procedure donor demise was observed in the sFGR twin compared with non sFGR twin; this was noted regardless of the defining method. Improvement in diagnosis of sFGR may aid in improving counseling and may affect management. Findings suggest the highest predictive value of Delphi method of defining sFGR based on presence of 2 of the 4 criteria for donor demise following FLS.