Effectiveness of a Standardized Clinical Management Protocol for Spontaneous Preterm Birth in Twin Pregnancies on Maternal and Perinatal Outcomes: A Retrospective Study

Abstract Purpose Spontaneous preterm birth (sPTB) occurs in 40–45% of twin pregnancies and is a leading cause of adverse perinatal outcomes. Single-modality interventions have shown inconsistent effectiveness. This study evaluated a standardized clinical management protocol for sPTB prevention in twin pregnancies. Methods This single-center retrospective study reviewed medical records of 150 women with twin pregnancies who delivered between January 2024 and June 2025. Based on the antenatal care model actually received, participants were divided into the study group (standardized protocol, n = 75) or control group (routine antenatal care, n = 75). The protocol included biweekly transvaginal cervical length measurements (14–24 weeks), fetal fibronectin screening at 22–24 weeks, structured patient education, psychological support, individualized nutritional counselling, and prespecified hospitalization criteria. The primary outcome was sPTB incidence (delivery at 28 to < 37 weeks); secondary outcomes covered gestational age at delivery, maternal and neonatal complications, NICU admission, and hospitalization costs. Results The sPTB incidence was significantly lower in the study group than in the control group (21.3% vs. 40.0%; P = 0.013), with a 46.8% relative reduction. Deliveries before 32 weeks were markedly reduced ( P = 0.008), and mean gestational age at delivery was significantly prolonged ( P < 0.001). Neonates in the study group had higher birth weights, lower NICU admission rates, shorter hospital stays, and lower hospitalization costs (all P < 0.05). Maternal postpartum hospital stay was also shorter in the study group ( P < 0.001). No protocol-related serious adverse events were reported. Conclusion A standardized clinical management protocol integrating serial cervical monitoring, fetal fibronectin (fFN) screening, education, psychological support, and nutritional counselling significantly associated with lower sPTB and improves perinatal outcomes in twin pregnancies.