Prophylactic cerclage in multiple pregnancies remains controversial, as evidence from studies is mixed. While some observational studies found cerclage decreased rates of preterm birth and low birthweight in triplet pregnancies, other studies found no differences in outcomes between cerclage and non-cerclage groups for twins or triplets. Large randomized controlled trials are still needed due to small sample sizes in past studies and lack of definitive evidence on cerclage's effectiveness. Patients at high risk of preterm birth also remain reluctant to enroll in randomized trials when cerclage is presented as a potentially lifesaving intervention based on observational studies.