Arguably the most common cause of perinatal mortality and morbidity in multiple gestation is spontaneous preterm labour and delivery. A number of interventions have been evaluated in preventing spontaneous preterm birth in this this context, namely, bed rest (with or without hospitalization), oral tocolytics, home uterine activity monitoring, use of progesterone, cervical cerclage and cervical pessary. Most of the research is in this area relates to twin pregnancy with very little dedicated to triplet and higher order pregnancies. There are conflicting results but in the main, sadly, an effective primary preventative intervention remains elusive. This chapter will summarise what we know about the efficacy of the aforementioned interventions and highlight some specific scenarios where intervention may be beneficial.