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Study quality was appraised with the Cochrane Risk of Bias tool. We performed pairwise inverse variance random\u2010effects meta\u2010analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main results<\/jats:title><jats:p>We included 23 trials (all but three were considered to have a low risk of bias) comprising 6626 women with twin pregnancies. None of the interventions significantly reduced the risk of preterm birth overall at &lt;34 or &lt;37\u00a0weeks of gestation, or neonatal death, our primary outcomes, compared to a control group. In women receiving vaginal progesterone, the relative risk (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>) of preterm birth &lt;34\u00a0weeks of gestation was 0.82 (95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.64\u20131.05, seven studies, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a036%), with a significant reduction in some key secondary outcomes, including very low birthweight (&lt;1500\u00a0g, <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a00.71, 95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.52\u20130.98, four studies, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a046%) and mechanical ventilation (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a00.61, 95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.45\u20130.82, four studies, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a022%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In twin gestations, although no overarching intervention was beneficial for the prevention of preterm birth and its sequelae, vaginal progesterone improved some important secondary outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Vaginal progesterone may be beneficial in twin pregnancies, but not 17\u2010<jats:styled-content style=\"fixed-case\">OHPC<\/jats:styled-content>, cerclage, or pessary.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.14513","type":"journal-article","created":{"date-parts":[[2017,2,8]],"date-time":"2017-02-08T01:10:59Z","timestamp":1486516259000},"page":"1163-1173","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":65,"title":["Preterm birth prevention in twin pregnancies with progesterone, pessary, or cerclage: a systematic 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