SummaryExcluding preterm deliveries before 33 weeks, macerated fetuses and congenitally abnormal babies, the perinatal risk was calculated separately for first and second twins and for breech and vertex twins delivered vaginally or abdominally. The perinatal mortality rate was higher for breech first twins born vaginally than for vertex fiat twins or for breech second twins. Caesarean section appeared safer than vaginal delivery but should be reserved for patients whose first twin is in a breech presentation.Perinatal loss in twin gestation has not been favourably influenced by attempts at preventing preterm labour. Attention has shifted to the intra-partum period with emphasis on the optimum mode of delivery, particularly for malpresentations (Kel-sick and Minkoff, 1982).