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Spontaneous Twin Pregnancy After Oophoropexy and Pelvic Radiation for Rectal Cancer. BACKGROUND: Pregnancy after adulthood pelvic radiation is rare. There is a paucity of literature to guide preconception counseling and pregnancy management for these patients. CASE: A 36-year-old woman, gravida 2 para 1001, was referred at 28 weeks of gestation with spontaneous twins, preterm premature rupture of membranes, and a history of rectal cancer that had been treated 3 years previously with oophoropexy, chemoradiation, and abdominal perineal resection. Delivery was complicated by difficult fetal extraction and resulted in the demise of twin A. CONCLUSION: Pregnancy after adulthood pelvic radiation is a potentially morbid event. Patients should be counseled about the potential delivery complications as well as the need for contraception after oophoropexy with intact fallopian tubes.