During an 11-year period, 23,524 deliveries were conducted at the University College Hospital, Ibadan; 4,360 (18.5%) were delivered by cesarean section, 49 of which were associated with twin pregnancy. The main indications for this operation in twin pregnancy were prolapsed umbilical cord, previous cesarean section scar and malpresentation of the second twin with the membranes already ruptured. The perinatal mortality of 18.2% was mainly attributable to prematurity. Obstetricians in this community have adopted a conservative attitude towards cesarean section because of the general aversion to this operation by our patients and the risk of subsequent rupture of the uterine scar in women who wish to deliver themselves at home in subsequent pregnancies. Cesarean section is therefore performed in twin pregnancy for the same absolute indications as for single pregnancy.