Preterm birth is the most common complication in twin pregnancies. Monochorionic twins，history of previous preterm birth，history of cervical surgery and advanced maternal age have been shown to be correlated with a higher risk of preterm birth in twin pregnancies. Transvaginal cervical length measurement during the second trimester is the best predictor for spontaneous preterm birth in twin pregnancies. For asymptomatic twin pregnancies with short cervix，fetal fibronectin（FFN）and amniotic fluid sludge screening may have additional predictive value. Clinical management of the risk of preterm birth in twins requires a detailed assessment of medical history and personalized management，including regular prenatal check-ups and ultrasound monitoring of cervical length and fetal conditions. Monochorionic diamniotic twins should be closely monitored for complications such as twin-to-twin transfusion syndrome（TTTS）and selective intrauterine growth restriction（sIUGR）. Vaginal progesterone may be beneficial in preventing preterm birth in twin pregnancies with cervical length ≤25mm，but its efficacy needs further validation by high-quality randomized controlled trials. Routine use of cervical cerclage is not recommended for twin pregnancies，although emergency cerclage may be beneficial when the cervix is extremely short and accompanied by dilation. Clinical decisions should take specific conditions of patients and the latest research developments into account.