The management of thoracoomphalopagus twins depends on gestational age and life expectancy of the fetuses. Vaginal route of delivery is limited to small nonviable fetuses. Cesarean section should be reserved for larger fetuses or when the life expectancy of the fetuses is of concern.The first case was that of heavily malformed fetuses of 28 weeks in preterm labor, delivered vaginally according to their parent's request, but the fusion between fetuses was torn cephalad. The second case was diagnosed and underwent cesarean section at her 29th gestational week, but her babies were lost after birth due to cardiorespiratory arrest. The third case was 34 weeks pregnant and not diagnosed until birth. Presentation of the first fetus was vertex, while the other was breech. Totally 3,700 g twins were delivered by vaginal route without any serious complication.Successful vaginal delivery of the third trimester fetuses is possible. The technique of the delivery is important.