The incidence of multifetal pregnancies has been increasing steadily. Fetal complications such as prematurity, discordant growth, intrauterine fetal demise, twin-twin transfusion, and congenital anomalies account for a large share of perinatal morbidity and mortality. Maternal complications from multiple gestations are also significant. Recent trends in antepartum management such as multifetal pregnancy reduction, specialized prenatal care, and well-timed delivery have improved outcomes. Intrapartum management, including the possibility of asynchronous birth and critical assessment of mode of delivery, has also led to better outcomes. This review provides a brief summary of each of these topics with, a particular focus on the recent literature.