Preterm birth remains a major cause of perinatal morbidity and mortality. A short cervix is strongly associated with spontaneous preterm birth. Professional organizations support cervical length screening for singleton gestations with a prior spontaneous preterm birth and second-trimester cervical length measurements between 16-24 weeks. All interventions used to decrease the risk of preterm birth in women with a short cervix are based on clinical trials that used transvaginal cervical length measurement, but transabdominal ultrasound has been shown to correlate well with transvaginal measurement in some observational studies. Transvaginal cervical length measurement is more accurate and more reliably obtained than the transabdominal approach. Conversely, transabdominal ultrasound could have the advantage of ease of implementation and, in general, is perceived by patients to be associated with less discomfort. Currently, there is no randomized clinical study that compares head-to-head the effectiveness of transvaginal vs transabdominal ultrasound for preterm birth risk screening. This point/counterpoint article summarizes the pros and cons of the 2 ultrasound approaches and debates whether transvaginal ultrasound should be used exclusively or if transabdominal ultrasound can be incorporated in cervical length screening for prevention of preterm birth.