Cervical cerclage is a common prophylactic intervention that has been used in the management of second trimester loss for several decades, yet it remains one of the more controversial surgical interventions in obstetrics. The diagnosis of cervical insufficiency is notoriously difficult to make, and is usually a retrospective one based on a history of recurrent second trimester loss (or early preterm delivery) following painless cervical dilatation in the absence of contractions, bleeding, or other causes of recurrent pregnancy loss. This article reviews the current literature regarding the efficacy of transvaginal cerclage (in both an elective and emergency setting), therapeutic cerclage (whereby a suture is inserted on the basis of ultrasound evidence of cervical shortening) and transabdominal cerclage.