Introduction: Twin pregnancies present unique challenges for both maternal and neonatal health. These pregnancies are associated with an increased risk of complications, such as preterm labor, growth restrictions, and higher rates of perinatal mortality. Methods: This prospective observational study was conducted at the Department of Gynaecology and Obstetrics in Dhaka Medical College and Hospital, Dhaka, from January 2008 to December 2008. Total number of cases were 132. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 20.0. A descriptive method was adopted in this study. Result: In this study of 132 twin pregnancies, 1.47% of deliveries were twins. Most patients were aged 20-35 years and multiparous. Preterm births accounted for 40.15%, with 43.93% of pregnancies reaching full term. Common maternal complications included premature labor (50%) and anemia (37.87%). The perinatal mortality rate was 10.98%, with prematurity (40.15%) being the leading cause of morbidity. Most twins had favorable APGAR scores (79.3% at 1 minute, 91.2% at 5 minutes), and birth weights were predominantly between 1.6-2.5 kg. Conclusion: This study concludes that twin pregnancies pose significant maternal and neonatal risks, including preterm labor, anemia, and hypertensive disorders in mothers, as well as prematurity and respiratory distress in neonates. However, the majority of neonates showed favorable outcomes with improved APGAR scores over time. While perinatal mortality was relatively low, proper management and early intervention are crucial in improving outcomes.