The intrauterine fetal death rate is six times higher than in singleton pregnancy. While only a small proportion of all pregnancies are multiple, they account for 12% of neonatal deaths.

·         High incidence of premature labour complicated l immature lungs and cerebral hemorrhage.

·         Low birthweight — IUGR and placental anomalies unique to multiple gestation. IUGR occurs in 25— 30% of twins.

·         Increased incidence of polyhydramnios and oligohydramnios (7% of twins).

·         Increased incidence of congenital anomalies (7%).

·         Fetal interlocking malpresentation.

·         Increased incidence of umbilical cord insertion anomalies.

·         Increased maternal complications, particularly

Antepartum hemorrhage

Pregnancy induced hypertension

Pre-eclampsia

Iron deficiency anemia

Hyperemesis

Pyelonephritis

Cholestasis.

Sonographic surveillance of these high risk pregnancy; should be routine because early diagnosis of complications leads to better management and reduction of fetal mortality.