Background: Twin pregnancy is a high-risl pregnancy with increased risk of obstetric complications. Objective: This study is to identify magnitude and obstetric Complications of twin deliveries at Nekemte Referral Hospital. Method: Hospital-based unmatched Case-control study design was carried-out on 104 sets of twin deliveries as cases and 208 singleton deliveries as controls conducted in obstetrics ward of Nekemte Referral Hospital from March 1, 2016 to February 29, 2017. The data were collected through pretested structured questionnaires and analyzed using SPSS version 20.0. The association between twin delivery and different variables were assessed by using odds ratio (OR) along with 95%CI. Results: The magnitude of twin deliveries was 28.6 in 1000 deliveries. The odds ratio of twin deliveries were significantly higher for the occurrence of hypertensive disorders of pregnancy, gestational diabetes mellitus, preterm delivery, pre-mature rupture of membrane, antepartum hemorrhage, cesarean delivery, anemia, postpartum hemorrhage, sepsis, and cord prolapse when compared to singleton deliveries. Conclusion: The magnitude of twin delivery in this study was high and numerous maternal complications were identified when compared to singleton deliveries. Thus, twin deliveries need greater attention during pregnancy, delivery and after delivery.