Background: Multiple births are much more common today than they were in the past. The incidence of twin gestation has increased mainly due to advanced maternal age and assisted reproductive technology Throughout the world, the prevalence of twin births varies from approximately 2-20 /1000 birth. This delayed childbearing has resulted in an increased maternal age at conception. Twin gestation is considered as high-risk pregnancy as it contributes significantly to adverse maternal and perinatal outcomes. This study was conducted to evaluate the risks of pregnancy complications and adverse perinatal outcome in women with twin pregnancy. Multiple pregnancies are associated with an increased risk of obstetric complications as well as perinatal morbidity and mortality especially in developing countries.