Purpose of review <p>This report will evaluate the current evidence on physical exam-indicated cerclage, a procedure performed for painless cervical dilation in the second trimester. We aim to clarify its indications, terminology and its clinical role in modern obstetrics.</p> Recent findings <p>Physical exam-indicated cerclage is performed in patients presenting with painless cervical dilation during the second trimester. Historically referred to as “rescue” or “salvage” cerclage, contemporary terminology favors the term physical exam-indicated cerclage to more accurately describe the indication for intervention. Growing evidence indicate that cerclage placement in appropriately selected patients can prolong pregnancy and improve neonatal outcomes. Systematic reviews and meta-analysis show increased pregnancy latency and neonatal survival compared with expectant management. Emerging data also suggest potential benefit in carefully selected twin pregnancies.</p> Summary <p>Physical exam-indicated cerclage is a valuable intervention in select patients with second trimester cervical dilation. Current evidence supports its role in improving perinatal outcomes, through careful patient selection remains essential. Future research should prioritize well-designed, adequately powered prospective trials to refine candidate selection criteria, standardize adjunctive therapies, and better define the role of cerclage at gestational ages beyond traditional thresholds of viability.</p>