Introduction: Multiple pregnancies are considered high-risk pregnancy. The commonest being twin pregnancy. It can lead to many maternal and perinatal complications. The global twinning rate has increased by a third, due to the dramatic increase in use of ovulation-induction drugs, IVF, and delayed marriages. To minimize the risks, patients with multiple pregnancies require close monitoring and frequent follow-up. Aim: To evaluate maternal and perinatal complications and pregnancy outcomes in women with twin pregnancies. Materials and methods: This is a retrospective observational study conducted in Municipal General Hospital and Medical College, Ahmedabad. During this study period of 2 years, there were a total of 10,682 deliveries, which include 142 women with twin pregnancies. We studied maternal factors like age, parity, complications, mode of delivery, and perinatal morbidity and mortality. Results: The incidence of twins in this study was found to be 1.32%. The most common maternal age was 20–25 years (mean age – 23.7) and higher incidence in multiparous women. Women with spontaneous conception – 96.4%. The most common fetal presentation was cephalic–cephalic presentation (59.5%). The commonest maternal complications were preterm (83.8%) and anemia (41.5%). Mode of delivery in our study 44.5% being vaginal birth and 55.6% women underwent lower segment cesarean section (LSCS). Neonates with birth weight less than 2.5 kg were 91.9%. Perinatal mortality was 11%. Conclusion: Twin gestation necessitates special attention as they contribute to maternal and fetal morbidity and mortality. Regular antenatal visits, adequate rest, administration of steroids, good nutrition, intensive neonatal care, and good health services can give fruitful outcomes.