Introduction:Twin gestation is a challenge in obstetrics constituting nearly 1% pregnancies. Associated with maternal and fetal complications, approximately 10% perinatal mortality. Aims and objectives: Studying the maternal risk factors, its effects, complications and perinatal outcome in twin gestation. Materials and methods: A retrospective analysis of 28 twin pregnancies done, JSS Research and Medical Hospital, Mysore, during 20 months study. Maternal factors like age, pregnancy complicating factors, method of child birth. Fetal outcome like newborn weight and difference, NICU care was studied. Results: This study had shown that, 75.3% mothers age was 20 to 24.5 years, 76% had spontaneous conception, 23.3% had infertility treatment 60% of the multigravida and 59% had twins. Half of the mothers had risk factor like anemia 50%, hypertension 30%, 75.6% had premature babies, 23% full-term regnancies. Of the 56 babies, 53% had very low birth weight, 28 babies needed NICU care. Fetal death of 12. No maternal mortality noted. Conclusion: Health sector has to give proper guidance to the antenatal woman for better output of mother and baby. Government has to implement necessary programmes to take care of multiple gestation mothers. Better obstetric care, neonatal care, good health services are needed.