What is the need for cervical cerclage? Do I need a cervical cerclage after a cervical LEEP or conization procedure? Should the endocervical opening be tightened? Which is better, MacDonald or Shirodkar cervical cerclage? Is cervical cerclage before or during pregnancy? And so on. After so many years of work, our team has collected more than 1800 cases of this type, but more than half of the pregnancies do not require intervention (meaning cervical cerclage, placement of cervical tray or special progesterone) and all I do is to monitor the cervix regularly. The following is the current opinion on the need for intervention during pregnancy: The key to clear evidence to support the need for intervention —— is how to take an accurate and comprehensive history: i. Typical cervical insufficiency (this type is true cervical insufficiency): this is the presence of “painless dilation-painless dilation “Mid-pregnancy miscarriage or preterm delivery, even if only once, requires intervention. The evidence for elective cervical cerclage is stronger. II. 2 or more midtrimester miscarriages or 3 or more very preterm births, with stronger evidence for elective cervical cerclage. Third, 1 midtrimester miscarriage or 1-2 very preterm births can be followed up with cervical length alone or with special progestins + follow-up cervical length, and cervical cerclage can be performed if the cervical length is less than 25 mm. Also some studies have shown that some of these people can be considered for cervical brace. IV. Emergency emergency cervical cerclage may be performed if cervical dilatation is found due to vaginal examination for a number of reasons (except in cases of impending or unavoidable miscarriage, and infection). V. Risk factors for twin births (e.g. history of mid-pregnancy miscarriage, history of preterm delivery, short cervix, etc.) may be considered for cervical bracing. VI. There is no history of mid-pregnancy miscarriage or preterm delivery, and special progesterone can be used for cervical ≤20 mm on ultrasound at delivery. Insufficient strength of evidence or no evidence i. No history of midtrimester miscarriage or preterm labor and a cervical finding of ≤25 mm on ultrasound at delivery is not an indication for cervical cerclage (there is some evidence that a cervical tray may be effective). Second, there is insufficient evidence for cervical cerclage in twin pregnancy warm-ups. Cervical procedures (e.g., LEEP or conization) do not always increase the risk of miscarriage or preterm delivery in the next pregnancy and need to be judged in relation to the “size or volume of the excision”. Fourth, the issue of endocervical dilatation —— is the main reason for the current overtreatment: the need for intervention based on endocervical dilatation alone lacks evidence and needs to be judged in relation to risk factors and trends.