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). Socio-cultural 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 fetal complications, which usually require a targeted antenatal and peripartum management. Chorionicity and amnioticity are key features that contribute to stratifying the risk for adverse outcomes. Twin gestations’ management as well as scientific research represent a relevant health global priority in order to optimize the antenatal management, and the obstetrics and long-term outcomes.