Despite advances in both obstetrics and neonatology the perinatal mortality rate (PNMR) among twins still remains high, estimated as accounting for approximately 10% of all perinatal mortality. Perinatal mortality rates (PNMR) for England and Wales showed a dramatic reduction in perinatal deaths for multiple births over the 1950s to 1980s with a fall from approximately 90 to less than 50 per 1000 births. The Northern Region Perinatal Mortality Survey Steering Group also reported a significant reduction in twin PNMR between 1982 and 1994 from 55.4 to 44.4/1000 births. A similar decrease has also been noted in the Japanese twin population with a reduction in the PNMR between 1980 and 1998 from 91 per 1000 births to 31 per 1000. In Scotland between 1986 and 1990 PNMR for twins was 47 per 1000 approximately 4-5 times the rate in the singleton population. The higher preterm delivery rate in twins, either from spontaneous or induced labour, with its associated problems of prematurity remains the major cause of morbidity and mortality. Other factors, which contribute to the higher PNMR in twins include fetal growth retardation, intra-twin birth weight discordancy, fetal anomalies and problems specific to monochorionic twin gestations.