Objectives: The aim of this study is to analyze the frequency and variety of twin births at the Clinic for Obstetrics and Gynecology in 2022 compared to 2012 and 2002, and to identify trends and factors that have influenced changes in the incidence and types of twin pregnancies. Material and methods: For this research, secondary data from the KBC Split databases for the years 2002, 2012, and 2022 were used. The pregnancy structure was analyzed through absolute and relative percentage frequencies, presented in tables and graphs. Changes were examined using the Z-test for differences in proportions, and the analysis was conducted using the statistical software STATISTICA 12 (Tibco, California). Results: Between 2002 and 2022, KBC Split recorded a significant increase in the number of cesarean sections for twin pregnancies, rising from 39.19% to 90.29%. During the same period, the proportion of spontaneous pregnancies decreased by 28.16%, while the number of pregnancies achieved through medically assisted reproduction increased. The incidence of preterm births, unfavorable fetal position during delivery, and birth weight of the twins remained unchanged. The average Apgar score improved from 7.5 to 8.9, and the need for intensive care for newborns decreased by 20% during the study period. Conclusion: The study suggests that, despite the increase in the number of cesarean sections, there are positive trends in perinatal outcomes, indicating progress in neonatal care. Higher Apgar scores and a reduced need for intensive care for newborns reflect improvements in the health and survival of newborns, which is important for future approaches to the care of pregnant women and infants.