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What you need to know when managing twins: 10 key facts. Twin pregnancies can be complicated. Early diagnosis with accurate dating, determination of chorionicity, screening for chromosomal and structural abnormalities, placental evaluation, and cervical length assessment should be completed in the first half of gestation. Routine fetal growth is recommended for all twins with serial surveillance for those complicated by anomalies, cervical shortening, growth disturbances, and amniotic fluid abnormalities. Twins with monochorionic placentation require heightened scrutiny for unequal placental sharing with discordant twin growth or selective intrauterine fetal growth restriction, twin-twin transfusion syndrome, twin anemia-polycythemia sequence, and single-fetal demise. Familiarity with essentials can assist practitioners involved in the management of twins.