Uncomplicated twin pregnancies are associated with more significant maternal hemodynamic changes compared to singleton pregnancies, likely due to volume overload, leading to more profound adjustments in the maternal heart. Cardiac remodeling occurs in response to these hemodynamic changes, with a documented tendency toward diastolic and systolic dysfunction in uncomplicated twin pregnancies. Chorionicity appears to influence maternal hemodynamic changes, with monochorionic twins exhibiting lower circulating volumes. Twin pregnancies with hypertensive disorders of pregnancy (HDP) are characterized by higher systemic vascular resistance (SVR) and reduced stroke volume (SV) compared to their uncomplicated counterparts. In monochorionic twin pregnancies, fetoscopic laser surgery for twin-to-twin transfusion syndrome (TTTS) seems to impact maternal hemodynamics.