Higher-order multiple births have implications for perinatal and maternal morbidity and mortality. This study aimed to determine the incidence and outcomes of higher-order multiple pregnancies in a rural area in Southeast Nigeria.The study reviewed the data on all higher-order multiple deliveries conducted in two tertiary health institutions in Abakaliki over a seven-year period from January 2000 to December 2006.Higher-order multiple births constituted 0.13 percent of the 16,968 deliveries at the two institutions. There were 21 triplet births and one quadruplet delivery. Mothers with higher-order multiple pregnancies had more antenatal admissions for preterm uterine contractions and had more preterm deliveries. The vaginal route was the preferred method of delivery. Stillbirth was recorded in 12.7 percent of the triplets, with 25.5 percent involving triplets I, II and III, who suffered birth asphyxia. The perinatal mortality rate was 276 per 1,000.The Igbo women of Ebonyi State, Nigeria, have a high rate of higher-order multiple births. These are attended by increased obstetric and perinatal complications. Abdominal delivery is therefore recommended in order to reduce the rate of intrapartum stillbirth and birth asphyxia among triplets.