**6. Conclusions for everyday practice**

Gestational CR is difficult to accurately predict for individual cases. Usage of serial ultrasound (16–23+6 weeks) for CL, resistant CL when funneling, cervical mucus plug distance, and cervical sliding sign are beneficial, when new techniques for cervical stiffness assessment (such as ultrasound strain elastography, SWEI) are not available for sPTB risk accurate prediction, or for vaginal progesterone failure in short cervix syndrome. Softness may be an alert sign for fetus abnormalities, membranes, and amniotic fluid, not only per se*.* Vaginal microbiota evaluation and correction for Döderlein bacilli presence is very important, associated with vaginal progesterone, with positive effects on vaginal and cervical inflammations reduction. Actually, vaginal micronized progesterone is a strong recommendation for short cervix <25 mm, in asymptomatic cases, for history of recurrent late pregnancy loss, sPTB <34, and < 37 weeks, with singleton/twins, being proved no adverse effect on offspring, cerclage (one/two stitches) and pessary are second or third line option, with CL, and stiffness monitoring after procedure, without stopping progesterone up to 36+6 weeks, to avoid prematurity, if mother's health permits; all three therapies may be used when high risks for sPTB, with advanced cervical changes, even when CL < 10 mm**.**
