INTRODUCTION: The American College of Obstetricians and Gynecologists recommends patients with a history of a preterm birth (PTB) be monitored with serial cervical length (CL) measurements for short cervix. We sought to evaluate the utility of serial CL surveillance in patients based on gestational age at the time of their prior PTB. METHODS: This was a multi-institutional retrospective study of pregnant patients with a history of spontaneous PTB between 23 weeks 0 days and 36 weeks 6 days that underwent a transvaginal CL between January 2017 and December 2021. Multiple gestation pregnancies were excluded. Data were compared between patients with a history of late PTB (>34 weeks) and patients with a history of early PTB (<34 weeks) using χ2 tests, t tests, and ANOVA analyses, as appropriate (α=0.05). Institutional review board approval was obtained for the study. RESULTS: Of 321 patients with a history of spontaneous PTB, 106 (33%) had a late PTB and 215 (67%) had an early PTB. Patients with a prior late PTB were less likely to be on 17-OHP (42.5% versus 54.5%, P=.04) and have a cerclage placed (4% versus 19.5%, P=.0002) compared to patients with an early PTB. Patients with a prior late PTB had their first CL performed at later gestations (18 weeks 0 days versus 17 weeks 2 days, P=.016) and fewer CL measurements (3.2 versus 3.5, P=.034). There was no difference in the gestational age that the shortest CL was detected (21 weeks 0 days versus 21 weeks 0 days, P=.98). CONCLUSION: In patients with either a history of early or late spontaneous PTB, universal CL surveillance at the time of the anatomy (18–20 weeks) may be sufficient to identify patients for intervention.