Objectives: The incidence of twin pregnancies has increased over the last decades. Twin pregnancy is associated with increased maternal and perinatal morbidity and mortality as well as healthcare costs. Hence in the present study an attempt has been made to study the annual trend, the probable etiological factors, demographic and obstetric characteristics, maternal and fetal complications of twin pregnancy in a tertiary care hospital. Method: A 3 year descriptive observational study was conducted in Lady Goschen Hospital and Kasturba medical college hospital, Mangalore from July 2014 to June 2017. A total of 218 women with twin gestation who had their pregnancy outcome in these hospitals were included in the study and the maternal, fetal and early neonatal complications studied. Results: There was a rising trend in the incidence of twin pregnancy. 12.84% of patients conceived with assisted reproductive technology. Twin pregnancy was common in 20-29 years age group (67.89%) and in multipara (55.96%). The average height and weight of the patients were 152.97cm and 60.44kg respectively. Preterm labor was the most common maternal complication (39.45%) followed by PROM (28.44%). Anemia (27.52%), hypertensive disorders complicating pregnancy (20.18%) were the most common medical disorders associated with twin pregnancy. Most twin pregnancies presented as vertex- vertex presentation (37.76%). The most common placentation was dichorionic diamniotic. 56.88% patients had preterm deliveries. 60.21% of the patients had cesarean delivery with the most common indication being malpresentation (36.62%). Majority of twins had low birth weight (91.32%). Perinatal mortality accounted for 10.71% of twins. Conclusion: Twin pregnancies are in the rising trend probably due to widespread use of assisted reproductive technology. Majority of twin pregnancies belong to high risk causing hazards to both mother and fetus. Early diagnosis, regular antenatal checkups, institutional delivery with good NICU facilities will help to improve maternal and fetal outcome.