In multiple pregnancy there is increased risk of adverse outcome for both mother and babies. Providing high quality antenatal care to optimize outcomes and effectively identify and manage complications is crucial. There are a number of additional elements of care recommended which herald the need for more monitoring and contact with healthcare professionals with appropriate expertise. Additionally, women and their families require emotional support and accurate reliable information to help navigate the anxiety and stress of these higher risk pregnancies. Early pregnancy care focuses on accurate gestational dating, determining chorionicity and amnionicity, and screening for fetal complications. Later in pregnancy care concentrates on identifying and managing growth pathology, preterm birth, maternal complications, and planning for delivery. Evidence to guide management of these challenging pregnancies is often lacking, in particular there is limited evidence to guide management for triplet and higher order multiple pregnancy. Fortunately, expert-led international guidelines to inform and support health care professionals to deliver the required care have been shown objectively to improve outcomes when implemented.