Prematurity, which occurs in about 12% of pregnancies worldwide, continues to be one of the leading causes of perinatal morbidity and mortality worldwide. Preterm birth (PTB) can still be considered a syndrome with a variety of causes and underlying factors, which results in mostly unnoticed contraction of the uterus and changes in the cervix. Despite considerable effort aimed at decreasing the incidence of spontaneous PTB, PTB remains the leading cause of perinatal morbidity and mortality. In light of the available data, screening strategies for PTB are deficient. Approaches used to identify women considered by historical factors to be low risk for preterm delivery, as well as those at high risk for PTB, continue to evolve. Ultrasound evaluation of the cervix during pregnancy has been the focus of much research during the past decades. Cervical measurement by transvaginal sonography (TVS) has been shown to be a good predictive test for spontaneous PTB in high-and low-risk singleton pregnancy. Cervical shortening, which is often detected on ultrasound examination before it can be appreciated on physical examination, is one of the first steps in the processes leading to labor and can precede labor by several weeks. This is likewise true for funneling and loss of cervical gland area, which cannot be assessed with the physical examination. Therefore, all of these markers, especially if they are used together, can be useful to predict PTB and start adequate therapy as soon as possible to prevent spontaneous preterm delivery.