Background: There is a continuous controversy regarding the obstetric perinatal outcome of multiple pregnancies conceived after assisted reproductive techniques (ART). There is an ongoing discussion whether theses parameters may show poorer results as compared to spontaneous conception. Aims: of the present study wereto compare the perinatal outcome in spontaneous multiple pregnancies compared to those conceived by ART and to design a booklet to orient the parturient women included in the study about spontaneously conceived and ART conceived multiple pregnancies. Design: A prospectivecohort observational study was used. Setting: The study was conducted at the labor ward at labor and child hood hospital, Zagazig University hospital. Subjects: Group A consisted of 83 parturient women with spontaneously conceived multiple pregnancies and group B which consisted of 27 parturient women with multiple pregnancies conceived by ART who were admitted to the study setting within a period of one year from January to December, 2015. Tools: Data collection tool consisted of 3 parts, structured interview questionnaire, labor record and neonatal record. Results: Group B were significantly complicated with threatened abortion and placenta previa than group A (24.0%& 24.0% VS. 7.1% &2.4% respectively). Premature rupture of membrane and severe preeclampsia were statistically significant main indications of emergency cesarean delivery in group A compared to group B, while placenta previa was a statistically significant amin indication for emergency CS in group B compared to group A (P= 0.032). As regards neonatal outcome, there were a statistically significant increase in the neonatal intensive care unit admission and still birth in group B compared to group A (64.0% & 22.0% VS. 46.4% & 2.9% respectively). Conclusion: Based on the findings of the study, When compared to spontaneously conceived twins, ARTconceived twins are more or less similar to those conceived spontaneously. Recommendation: Multiple pregnancy in general whether conceived spontaneously or by ART techniques require proper antenatal, intra-natal and postnatal care as it poses several risks on both mother and fetus. Keywords: Multiple pregnancy, spontaneous pregnancy, assisted conception, outcome.