Preterm premature rupture of membranes (PPROM) occurs in 38% of women with cerclage in place. Controversy exists on what to do with the cerclage in this clinical scenario. The objective was to review the literature addressing retention versus removal of cerclage after PPROM and present management recommendations. Retention of cerclage for more than 24 hours after PPROM was found to prolong pregnancy for more than 48 hours, but also to increase maternal chorioamnionitis and neonatal mortality from sepsis, making immediate cerclage removal as the usually preferred therapeutic approach. Steroids for fetal maturity before cerclage removal can be considered between 24 and 33 6/7 weeks gestation.