The intrapartum management of the twin pregnancy has remained a controversial and challenging issue in obstetrics. Development of a management plan for delivery of a twin gestation necessitates consideration of multiple factors including fetal presentations, gestational age, estimated fetal weights, the presence of maternal or fetal complications, and the experience of the attending obstetrician, anaesthetic staff and neonatologists. In twin gestations in which a trial of labour is possible, the major factor determining the intrapartum course is the relative presentations of twin A and twin B on admission to the delivery suite.