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Background: High-order twin pregnancy remains a serious challenge for both the clinicians and the mothers during pregnancy and after delivery with increased maternal and perinatal morbidity and mortality. Case Presentation: We present a case of a 27-year-old Gravida 2 Para 1+0 at 36 weeks and 2 days admitted in preterm labor in the second stage who successfully delivered four live babies three vertex and one breech. Conclusion: Early diagnosis of high-order twin pregnancy and referral to an appropriate specialized health center is crucial in reducing associated maternal and perinatal morbidity and mortality. [ABSTRACT FROM AUTHOR]