Early pregnancy cervical remodeling is a multifactorial process that may lead to shortened cervix and cervical insufficiency. Cervical insufficiency is the inability for a cervix to retain a fetus in the uterus in the second trimester due to painless cervical dilation. Patients with cervical insufficiency may experience recurrent second trimester losses or spontaneous preterm births, leading to maternal and neonatal physical and emotional complications. Management of early cervical remodeling is dependent on clinical and ultrasound findings as well as patient history and may include vaginal progesterone and/or cerclage.