Although the term "cervical incompetence" was first used in The Lancet in 1865, the contemporary concept was not widely accepted until the middle of the 20th century, after Palmer and Lacomme in 1948 and Lash and Lash in 1950 independently described interval repair of anatomic cervical defects associated with recurrent spontaneous midtrimester birth. Soon thereafter, Shirodkar in 1955, McDonald in 1957, and later Benson and Durfee in 1965 described the cerclage procedures utilized in contemporary obstetric practice. Nevertheless, the literature on cervical insufficiency (the preferred contemporary term) has largely been a chronicle of surgical methods to correct often posttraumatic anatomic disruption of the internal os, in women who had experienced recurrent painless dilation and midtrimester birth. Evidence-based guidelines for many aspects of the diagnosis and management are still lacking. © 2012 John Wiley and Sons, Ltd.