Multiple pregnancies are associated with an increase in fetal and neonatal mortality compared with singleton pregnancies. The perinatal morbidity and mortality increase with increasing order of multiple pregnancy. The differential loss rate is mainly the result of twin-twin transfusion syndrome which accounts for 20 percent of stillbirths in multiple pregnancies. Growth restriction of one or more of the fetuses in a multiple pregnancy is very common. Chorionic villus sampling (CVS) is also possible in multiple pregnancies. Although CVS carries a higher loss rate, it has the advantage of being performed earlier, but may be less reliable than amniocentesis as up to four percent of CVS samples show evidence of co-twin contamination. The management of a multiple pregnancy is a major challenge for obstetricians. There is an increasing vogue to manage these patients in specialized multiple pregnancy clinics, with access to a fetal medicine specialist with a special interest in multiple pregnancy.