Twin pregnancy is a condition of great relevance in maternal-fetal medicine due to the increasing trend in its prevalence worldwide (3–4% of all pregnancies). Sociocultural and economic changes are largely contributing to this trend (increased maternal age, postponed family planning, assisted reproductive technologies). The medical importance of twin pregnancy translates into its higher risks for several maternal and/or fetuses complications, which usually require a targeted antenatal and peripartum management. Chorionicity and amnionicity are key features that contribute to stratify the risk for adverse outcomes. Twin gestations’s management as well as scientific researches represent a relevant health global priority in order to optimize the antenatal management, and the obstetrics and long-life outcomes.