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RCOG World Congress 2025

June 23 - 25, 2025 | ExCeL London, UK

PP.0030

Ultrasound training package assessing the cervix and Caesarean Section scar in pregnancy.

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Poster Presenter

Charlotte Colley

Authors

Charlotte Colley, Katarzyna Maksym, Natalie Greenwold, Amrita Banerjee, Maria Ivan, Katharine Clements, Davide Casagrandi, Amos Tetteh, Raffaele Napolitano, Anna David

Affiliations

Women’s Health Division, University College London Hospital (UCLH)

Part of Topic

Imaging in obstetrics

Validation of a scoring system and development of a training package for assessment of caesarean section scar characteristics and cervical length in pregnancy.

BACKGROUND

Previous Caesarean Section (CS) at full dilatation increases the risk of spontaneous preterm birth (PTB) in the next pregnancy. CS scar position and size can be assessed by mid-gestation transvaginal ultrasound scan (USS). A CS scar close to the internal os increases the risk of shortening cervical length (CL) and spontaneous PTB.

AIM

To develop a scoring system and USS training package to assess CL and CS scar characteristics during pregnancy using a validated technique.

METHODS

A 6-point image scoring system was developed and validated by two experts:

- Anonymised USS images were subjectively and objectively scored.

- 38 images giving six independent binary scores needed >80% agreement to validate the scoring system.

The training video was developed with input on the script from patients with lived experience of PTB.

- The animation was created and illustrated with anonymised videos of 2D USS with patient consent.

- Anonymous feedback was acquired from 20 UK PTB experts.

RESULTS

The 6-point objective image scoring system includes: essential criteria for CL measurement, CS scar position (distance from internal os), and CS scar niche measurements. There are optional additional criteria (not included in validation).

Experts had overall agreement:

- Objective evaluation = 80.7% (184 of the 228 criteria matching)

- Subjective evaluation = 76.3%

The training video has animation: key annotations, and voiceover description, providing linguistic, visual, aural, and spatial learning.

Qualitative feedback on the video was analysed based on key themes: clear explanations, learning multimodal, and clinically relevant.

CONCLUSION

We have validated a 6-point scoring system of transvaginal 2D USS images of the cervix and CS scar. Objective image assessment was more reliable and reproducible than subjective. PTB experts found the training video to be effective and clinically applicable. The training package is ready for use.