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Background: Multiple pregnancies are associated with an increased risk of obstetric complications as well as perinatal morbidity and mortality especially in developing countries. The present study aims to identify socio-demographic, obstetric, and maternal complications associated with any adverse perinatal outcome in singleton and twin deliveries in the department of obstetrics and gynaecology at the R. D. Gardi Medical College in Ujjain between September 1, 2021 and December 31, 2022.. Methods: This comparative prospective study was conducted in the department of obstetrics and gynecology, R. D. Gardi Medical College in Ujjain between September 1, 2021 and December 31, 2022. Consecutive sampling was done till the sample size of 142 was reached for both twin and singleton pregnancies. It included all women admitted in antenatal ward and labor room with clinical or ultrasound diagnosis of twin pregnancy after 28 weeks of gestation. Results: The incidence of twins in this study was 1.85%. Mean maternal age was 24.08±2.73 years for twin pregnancies and 24.08±3.56 for singleton pregnancies. Twins were seen more in multigravida as compared to primigravida. Preterm labor (40%), anemia (26.5%) and hypertensive disorders (14.3%) and PPH (6%) were the most common complication in twin pregnancies. Significantly higher rate of LSCS were seen in twin pregnancies (30.6%) as compared to singletons 17%. There was higher incidence of moderate to severe asphyxia, IUGR and higher rate of NICU admissions in twins as compared to singletons. Conclusions: Early diagnosis, good antenatal care with early recognition of complications and their timely referral and management at a tertiary care with level 3 neonatal care can help reduce maternal and perinatal mortality and morbidity. Prompt ANC care and timely intervention is required to avoid these complications. [ABSTRACT FROM AUTHOR]