A unicornuate uterus pregnant with twins can be dangerous, with the risk of uterine rupture, hemorrhage, and other serious and potentially life-threatening conditions. Unicornuate uterus is one kind of uterine anomaly, it is a chromosomal abnormality during embryonic period, resulting in the development of one side of the paramesonephric ducts while the other side of the paramesonephric ducts did not develop or did not form the ducts, this kind of women’s chances of getting pregnant will be reduced, even if the success of the pregnancy is more risky. The shape of unicornuate uterus is smaller than the normal uterine shape, and the uterine cavity is also smaller. Pregnancy with a single fetus will have an impact on the normal growth and development of the fetus, and it is easy to have miscarriages, preterm labor, and malpositioning of the fetus in pregnancy, and carrying a twin fetus is even more detrimental to the growth of the fetus, and it is also prone to dangers. With the increase of pregnancy weeks and the enlargement of the uterus, the part of the uterus may become thinner, and there is a risk of uterine rupture and hemorrhage in the course of pregnancy, which may jeopardize the life of the mother and child if not rescued in time. A unicornuate uterus is not recommended for pregnancy with twins, and the continuation of pregnancy with twins should be carefully considered.