About 3.2% of live births comprise twins, and 20% account for preterm labor, with delivery of twins before 37 and 32 weeks of gestation approximately 60% and 10.7%. About five times elevated risk of initial neonatal and infant mortality is noted in the case of twin pregnancy in preterm parturition cases. Both spontaneous and indicated preterm labor is observed more in monochorionic twins than in dichorionic twins. Prediction and diagnosis of preterm labor is effectively done using transvaginal ultrasound to compute the length of the cervix before 24 weeks without any risk. Vaginal administration of progesterone in women with less than 25 mm cervical length is beneficial to prevent preterm and neonatal obstacles in twin pregnancies. Physical evaluation showed women undergoing cerclage surgery, when cervical dilation is greater than 1 cm, have lowered the risk of perinatal death and preterm labor at varied gestational stages. In a few studies, twin delivery is not directly associated with preterm and related complications. However, pregnancies weighing less than 1000 g are associated with major disability around year 1 compared to singleton preterm. All these considerations are crucial in order to optimize the antenatal management of this group of pregnancies destinated to show an increasing trend.