Decision of perimortem caesarian section (PMCS) is always difficult specially in a non-obstetric critical care setting. A 32-year-old 2nd gravida women with EGA OF 34 Weeks and twin pregnancy was admitted to medical critical care unit of a tertiary care Centre with severe type 1 respiratory failure. Patient suffered a cardiac arrest soon after the admission. Decision of PMCS was taken after 3 min of high quality CPR with failure to achieve ROSC Return of spontaneous circulation). PMCS was done within 5 min of cardiac arrest and both the babies were delivered within one minute of incision. Both the babies were discharged after 8 days of birth. The mother however could not survive died in the second event of cardiac arrest. The challenges of performing CPR in pregnancy, facilitating a “Twin Delivery” and managing neonatal resuscitations in an adult critical care unit are discussed in this report.