The chapter covers cases associated with multifetal pregnancy that can be part of any gynecologist casualty. Differences in overall incidence of twinning are due to variable frequencies in the prevalence of dizygotic twins. Dizygotic twinning varies from 4–50 per thousand births, depending upon ethnicity, age, height, weight, parity and availability of assisted reproduction facilities. Twinning that occurs because of fertilization of two separate oocyte is called as dizygotic twinning. Twinning in which a single fertilized oocyte subsequently divides into two identical structures is known as monozygotic twinning. The topics covered are the need for first trimester screening in multifetal pregnancy, sensitivity and specificity of combined screening, monochorionic twin pregnancy, acardiac twin pregnancy, role of nutrition in twin pregnancy, role of induction of labor in twin pregnancy after 36 weeks of pregnancy, triplet pregnancy and many more other topics.