Preterm labor (PTL) in a multiple gestation occurs frequently and is a common reason for preterm delivery (PTD). Management strategies for multiple gestations must be directed at early detection of PTL and effective strategies to delay or prevent PTD. Unlike singleton gestation where identification of patients at risk for PTL is often difficult, every multiple gestation is at risk for PTL, so all patients can be managed as being at risk. Although PTL is a significant cause of PTD, one must recognize that there are other reasons for delivery in multiple gestations. Clinicians must treat the whole patient and extend the pregnancy to the most advanced gestational age possible that is consistent with the best outcome.