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Objective:To compare matal outcome of multiple versus singleton pregnancies at a tertiary hospital inTanzania.Methods:A case control study was designed using matally linked data fromKilimanjaroChristianMedicalCentre(KCMC) medical birth registry for the period of2000-2010.A total of822 multiple gestations(cases) were matched with822 singletons(controls) with respect to matal age at delivery and parity.The odds ratio(ORs) with95% confidence intervals (CIs) for adverse matal outcome between singleton and multiple gestations were computed in a multivariable logistic regression model.Results:Of the33997 births, there were822(2.1%) multiples.Compared with singletons, women with multiple gestations had increased risk for preeclampsia(OR2.6;95%CI:1.7-3.9), preterm labour(OR5.6;95%CI:4.2-7.4), antepartum haemorrhage(OR1.6;95%CI:1.1-2.3), anaemia(OR2.0;95%CI:1.6-2.6) and caesarean section (OR1.5;95%CI:1.4-1.7).In addition, there were six matal deaths among women with multiple gestations, of which all were attributed to postpartum haemorrhage.This accounted for a case fatality rate of15.8%.Conclusions:Multiple gestations are associated with adverse matal outcomes.Close follow-up and timely interventions may help to prevent poor outcomes related to multiple gestations.These findings suggest the needs for clinicians to counsel women with multiple gestations during prenatal care regarding the potential risks.