Introduction: Intrapartum management of twin pregnancy has significant potential for perinatal damage and has always been a topic of controversy. The study evaluates the antecedant and intrapartum events where a combined delivery was required. Method: Retrospective analysis of medical records of 479 twin pairs delivered over a period of 5 years, in a tertiary care teaching hospital. Various maternal and fetal outcomes were studied. Results: Out of 479 twin deliveries, 156 were delivered by caesarean and 308 vaginally. 15 required a combined delivery. Malpresentations, fetal distress and abruption were associated with increased risk of combined delivery.