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ObjectiveTo compare maternal and neonatal outcomes in women with a previous history of pregnancy loss and/or preterm delivery who underwent ultrasound-indicated cerclage (UIC) or history-indicated cerclage (HIC).MethodsPubMed, Web of Science, Scopus, and Embase databases were searched for observational studies and randomized controlled trials (RCT) from inception to 30 April 2024. Eligible studies should have compared the outcomes of women with singleton pregnancies who underwent UIC or HIC. STATA version 15.0 was employed, and the analysis was done using a random effects model and unadjusted effect sizes from the included studies.ResultsOf 25 included studies (n = 3909), most (n = 18) were retrospective cohort studies. Compared to women who underwent HIC, UIC was associated with higher risk of having a preterm birth (ConclusionOur results demonstrate that UIC is associated with higher risks of adverse pregnancy outcomes compared to HIC. However, our evidence emanates from observational studies and is prone to biases, particularly because the findings were unadjusted for potential confounders. More clinical trials are needed to confirm our observations.Systematic review protocol registrationPROSPERO CRD42024544181