Twin pregnancy refers to a pregnancy where the mother carries two fetuses in utero at the same time. Twins can either be monozygotic or dizygotic. The rate of multiple pregnancies has increased over the last few decades which is attributed to rising average maternal age, a decline in fertility and an increase in the use of assisted reproductive techniques. Both maternal and fetal complications are significantly raised in multiple gestational pregnancy. This study has been undertaken to analyze neonatal outcome in twin gestational pregnancy and to have better knowledge of maternal and perinatal complications. This was a retrospective observational study conducted at a tertiary care hospital in the city of Ahmedabad over a period of one year (1st January 2022 to 31st December 2022). All twins admitted in the PNC ward, in the NICU and IUD babies were included in the study. Data was collected with detailed proformas from case histories of both the mother and the babies’ case papers and was analyzed according to appropriate statistical methods. A total of 62 sets of twins (124 babies) were studied through the study duration. Most of these twins were delivered by LSCS at term gestation. However, majority of the babies born were Low Birth Weight babies. A mean weight of about 1.7 kg was seen in our study group. It was observed that 57.25% of the neonates were admitted into NICU for further management of complications. Although the complications associated with twin pregnancies cannot be prevented but can be better managed, through timely diagnosis and intervention for the same and equal involvement of both the obstetrician and pediatrician in management of these cases. Some of the complications of the admitted neonates – such as birth asphyxia, prematurity, and TTNB – are difficult to prevent; a few other complications such as RDS, neonatal jaundice, and sepsis can be prevented by ensuring appropriate antenatal interventions and proper counselling and guidance of mothers for care for twin babies. A multiple gestation pregnancy poses a challenge for both the obstetrician and the pediatrician.