Conjoined twins, known to the layperson as Siamese twins, are a rare and catastrophic obstetric event. With the approximate incidence being 1 in 50,000 births, few physicians practicing obstetrics will have the unfortunate occasion to manage this biologic anomaly. Should this event occur, early diagnosis, close prenatal management, and the proper route of delivery will assure the best possible outcome for mother and both babies. The author describes the anatomic types of conjoined twins, the prenatal diagnosis and management, the route of delivery, and the overall statistical expectation. Under the best of circumstances, a good outcome is rarely achieved, but the obstetric goal should be a healthy mother and two salvageable babies.