AbstractObjective: The purpose of the study was to determine whether the use of prophylactic oral ritodrine or hospitalization for bed rest can prolong pregnancy in multiple pregnancy. Methods: The study was conducted over a period of 8 years and included 189 cases of multiple pregnancy, all of which were delivered at the King Fahd Hospital of the University, Al‐Khobar, Saudi Arabia, between July 1986 and August 1994. The patients were divided into three groups: the first group included 64 patients who received oral ritodrine from the 25th to the end of the 37th week of gestation; the second group included 57 patients who were hospitalized from the 28th to the 32nd week of gestation; and the third group, considered the control group, included 68 patients who were managed on an outpatient basis only. Forty‐six cases of multiple pregnancy were excluded from the study for a variety of reasons. Results: The study showed an increase in gestational age at delivery, an increase in mean birth weight and a reduction in preterm delivery in the group treated with prophylactic ritodrine (P = 0.03). In the hospitalized group there was no effect on duration of gestation or reduction in preterm delivery, but there was an increase in mean birth weight (P = 0.04). Several patients experienced troublesome side effects with ritodrine. Conclusion: Our study indicates that the prophylactic use of β‐sympathomimetics is more effective, beneficial and less expensive than hospitalization for bed rest in prevention of preterm labor and delivery in multiple pregnancy.