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Objective The objective is to evaluate efficiency of using internal protocol of prophylaxis preterm birth (PB). Materials and methods Three hundred and seventy gravidas without clinical symptoms of preterm delivery with cervical canal length of <25 mm and on <21 gestation weeks were inspected. Protocol included anamnesis research, 200 mg of daily vaginal progesterone, ultrasound monitoring of length and shape of cervical canal, and distinguished treatment of cervical insufficiency using cerclage or cervical pessary. Results Gravidas whose protocol was fully attended have more than dual-fold decrease of extra early preterm delivery risk ratio [4.3 vs 12.3% relative risk (RR) 0.47; 95% confidence interval (CI) 0.23–0.99], compared with those whose protocol was attended fractionary. Quantity of unprompted miscarriages in 22+0 week period also decreased dual-fold (6.6 vs 13.8%; RR 0.47; 95% CI 0.23–0.99). The most common mistakes were ignorance of anamnesis data, wrong choice of ways of correction cervical insufficiency, long and ineffective treatment of genital tract infections, and inaccurate estimation of cervical canal. Summary Usage of effective medication, development of new clinical protocols, and detailed abidance of earlier accepted protocols, mistakes’ analysis, and staff training are reserves of extremely PB decrease. How to cite this article Belotserkovtseva LD, Kovalenko LV, Ivannikov SE, Mirzoeva GT, Petrova TG. Cervical Incompetence: Modern Clinical Protocols and Real Practice. Donald School J Ultrasound Obstet Gynecol 2017;11(3):203-209.