Background: Preeclampsia accounts for 10 to 15 % maternal deaths globally, corresponding to 50,000 annual maternal deaths. Twin pregnancy is a known risk factor for preeclampsia and it is also associated with increased adverse perinatal and maternal outcomes. Inadequate data exists regarding the clinical characteristics and perinatal outcomes of twin pregnancies with preeclampsia. Methods: A facility based case-control retrospective study was conducted; a structured questionnaire in English language with sections of socio-demographic data and obstetric characteristics was used to extract data from maternal charts and neonatal intensive care unit (NICU) registry book. Statistical test of association was done using Chi square for categorical data; strength of association with OR and 95% CI .Those variables with P-value of <0.2 on univariate analysis were entered into multivariable logistic regression analysis and adjusted OR was calculated Results: The frequency of preterm birth was 61.9% in the PE group which was statistically different from that observed in the normotensive ones (33.6%) at p-value of <0.0001. Delivery at gestational age less than 34 weeks was also significantly higher in the preeclampsia group (12.7 % Vs. 9% at p-value of 0.001). Conclusions: In this study, twin pregnancies complicated with PE was associated with significantly increased rate of preterm birth, including delivery less than 34 weeks. We recommend a further well-designed prospective analytic study
