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The aim is to describe the performance of first-trimester combined risk assessment in twin pregnancies.Maternal serum free beta-human chorionic gonadotrophin and pregnancy-associated plasma protein A (PAPP-A) were determined at 8 to 12 weeks and fetal nuchal translucency (NT) was measured at 11 to 13+6 weeks. The individual risk was estimated for each fetus using the combined test in dichorionic twins. In monochorionic twins, the mean risk assessment of the two fetuses was used. An invasive diagnostic procedure was offered when the risk was ≥1 : 270 in either one of the fetuses.From February 2007 to June 2011, 447 twin pregnancies were enrolled in this study. There were 402 (89.9%) dichorionic and 45 (10.1%) monochorionic twins. In dichorionic twins, mean crown–rump length (CRL) was 63.9 mm; median NT multiples of the median (MoM) was 0.97; median B-hCG was MoM 1.74; median PAPP-A was 1.72. In monochorionic twins, mean CRL was 61.9 mm; median NT MoM was 0. 98; median B-hCG MoM was 1.44; and median PAPP-A was 1.51. Two pregnancies with Down syndrome were detected by first trimester screening, both in dichorionic twins. The false positive rate was 5.7% (95% confidence interval 4.1–7.3) and 4.4% (95% confidence interval 0.1–8.8%) in dichorionic and monochorionic twins, respectively.The combined test in twins appears to be a good method for Down syndrome screening with a high detection rate and an acceptable false-positive rate.