Cervical incompetence is one of the causes of preterm delivery and pregnancy loss. In some women, the cervix opens prematurely and the typical scenario involves painless dilatation of the cervix in the second trimester (often around 16-18 weeks). This then leads to premature rupture of membranes and loss of the pregnancy, often before viability. A cerclage is basically a suture that is tied around the cervix in order to prevent it from opening too soon. The traditional cerclage is placed through the vagina and this is often done at around 12-14 weeks of pregnancy. The vaginal cerclage can be effective, but unfortunately does not always help. In the setting of a failed vaginal cerclage, it has been well demonstrated that an abdominal cerclage is more effective. This used to be placed through a large incision, but a laparoscopic cerclage is just as effective and has the advantage of allowing patients a quick (one week vs. 8 weeks with a large incision) recovery. Dr. Einarsson has performed approximately 200 laparoscopic cerclage procedures, which is one of the largest series of this procedure in the United States. In his most recent publication from his data, the efficacy of the laparoscopic cerclage was about 97%. Many of these patients had endured multiple losses prior to this procedure. The laparoscopic cerclage is generally placed prior to pregnancy, but can also be placed during the first trimester of pregnancy. It is recommended that patients wait 2 months to get pregnant after placement and the mode of delivery will have to be a cesarean section. If a miscarriage occurs, then evacuation can still be done with the cerclage in place. Patients do need frequent surveillance by an expert in high risk obstetrics during their pregnancy. If the cerclage looks good at the time of the cesarean section, it can be left in place to be utilized in future pregnancies. It is not necessary to remove it even if the patient is not planning to have more children.