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Introduction-High risk pregnancy is defined as one which is complicated by factors that adversely affect the pregnancy outcome- maternal or fetal. The prevention of high risk pregnancy in Indian women is 49.4% with 33% of women having a single risk and 16.4% women having multiple high risk pregnancy Case presentation- Here we present a case of a 36 year old female, G4A2E1 conceived DCDA twins through IVF, underwent cervical encerclage at 17 weeks with a know case of hypothyroidism since 2 years and developed Gestational diabetes mellitus , preeclampsia, intrahepatic cholestasis of pregnancy . Patient had a history of laparoscopic myomectomy and hysteroscopic resection of uterine septum before IVF. Conclusion - Patient underwent an Elective LSCS at 36 weeks and delivered a female baby weighing 2.26kg and male baby of 1.72kg at 36 weeks .