THE ISSUE: Undeniably, the 2 major risk factors for preterm births, the bane of modern obstetrics, are history of spontaneous delivery <37 weeks and transvaginal cervical length <2.5 cm. A multicenter randomized clinical trial has evaluated the role of cerclage for women with these 2 risk factors and concluded that intervention is associated with improved outcomes. Despite the level I evidence for cerclage, there is controversy about when to cerclage and if 17-hydroxyprogesterone prophylaxis is sufficient.