Objective: This study was aimed to study the prevalence of twin pregnancy in a tertiary care hospital in Karad and to evaluate the various factors that influence maternal, fetal, and neonatal outcomes of twin gestation. Methods: This retrospective study was conducted at a tertiary care hospital in Karad, Maharashtra, for a period of two years. All women admitted with twin pregnancy (>28 weeks gestation) were considered for study. Maternal data including age, gestational age, parity, mode of conception, maternal interventions, mode of delivery, fetal death, intrauterine fetal growth restriction (IUGR), twin to twin transfusion, neonatal intensive care unit (NICU) admissions, birth asphyxia, low birth weight (LBW) and respiratory distress were recorded and analyzed Results: Incidence rate of twin pregnancy was 1.9%. Most women (56.48%) were aged 21-30 years and have completed 34-36 weeks of gestation (48.15%) with average gestational age of 34.97±2.35 weeks. Malpresentations (37.96%) followed by preterm labour (35.1%) was most common maternal complication. Cesarean section (62.04%) was most frequent mode of delivery. Most neonates had LBW (92.34%) and required NICU admissions (19.6%). Total rate of neonatal mortality is 3.34%. Birth asphyxia (42.85%) was the most frequent cause of neonatal mortality. Conclusion: Twin gestation necessitates special attention as there is increased risk of maternal and perinatal morbidity and mortality. Early detection and anticipation of complications of twin gestation can greatly improve the maternal and fetal outcomes.