In this article efficacy of fetoscopic laser coagulation of placental anastomoses in the improvement of perinatal outcomes of monochorionic multiple pregnancy, complicated by twin-to-twin transfusion syndrome has been investigated in order to select the optimal approaches to the dynamic management of patients and fetuses in the postoperative period and subsequent pregnancy. A prospective study of pregnancy outcomes was conducted with monochorionic diamniotic twins complicated by twin-to-twin transfusion syndrome, which was an indication for performing laser coagulation of placental anastomoses in the period from 2008 to 2012 in 30 patients. The average term of delivery among all pregnant women of the study group after the fetoscopic laser coagulation was 31,35±1,19 weeks, the median was 33,5. Analysis of the fetal survival curve revealed that most of the fetuses died on the 1st day after the operation, the cumulative probability of survival on day 1 was 70 %, survival at day 7 after surgery was 63 %. In groups of pregnant women with placental localization along the anterior and posterior walls of the uterus, according to the exact two-sided Fisher test, no statistically significant differences in the overall survival of the fetuses, the survival of one and both of the twins were found. The use of fetoscopic laser coagulation is effective in reducing the frequency of perinatal losses in twin-to-twin transfusion syndrome. The results of the fetal survival within 7 days after fetoscopic laser coagulation in our study corresponded to literature data (survival of one fetus - 84,6 %, both fetuses - 69,2 % of cases). Accumulation of the surgeon’s experience in carrying out fetoscopic laser coagulation allows to reduce the duration of the operation (from 120 to 50 minutes) and, accordingly, the risk of early postoperative complications in relation to the mother.