Routine serial nonstress fetal heart rate testing was evaluated in 94 patients with multiple gestations (193 fetuses). Reactive testing was associated with an uncomplicated perinatal outcome in 89% of the cases. Nonreactive fetuses had a significantly higher incidence of perinatal morbidity, including fetal distress in labor (77.8%), asphyxia (48%), and intrauterine growth retardation (28%). Overall perinatal mortality (21/1000) was nearly comparable to that observed in singleton pregnancies. Nonreactive fetuses had a perinatal death rate that was more than six times that of the reactive ones (80/1000 versus 12/1000). Antepartum nonstress testing was found to be a highly reliable and predictive tool in the assessment of multiple gestations.