Abstract Background: In spite the fact that the prevalence of preterm birth has increased, several treatments have been identified as having a possible role in reducing the risk of repeated preterm birth (PTB), such as bed rest and vaginal progesterone, which have been tried to ameliorate this dis-tressing condition. Aim of Study: To compare the efficacy of vaginal proges- terone and cerclage in preventing preterm birth. Patients and Methods: This study was a prospective cohort randomized clinical study that was conducted on 120 pregnant women at high risk of preterm birth; 60 cases were prescribed vaginal progesterone and the remaining 60 cases underwent cervical cerclage. They were all chosen from the outpatient clinics at Al-Hussien University Hospital and Kafr El-Sheikh General Hospital during the period from March 2020 till December 2020. Results: It was observed that in cases who received vaginal progesterone the mean gestational age was (35.76±2.33 weeks) while it was (36.32±2.12 weeks) in those who underwent cerclage. The mean gestational age improved in the cerclage groups by about 3.92 days. The gestational age at delivery was higher in the cerclage group than that in the progesterone group, but without significant difference. As regard neonatal outcome of the current delivery, the overall morbidity was shown in 22 cases (19.8%) and mortality was 5 (4.5%). Conclusion: Both vaginal progesterone as well as cervical cerclage had a significant beneficial impact in opposition to preterm delivery and improving perinatal consequences among the high-risk singleton pregnant ladies with former spontaneous PTB.