Improving Cervical Assessment Compliance During Second-Trimester Morphology Ultrasound: A Multiphase Quality Improvement Study.

Abstract

Background: Cervical length assessment during second-trimester morphology ultrasound is essential for identifying women at risk of spontaneous preterm birth. Although transabdominal (TA) assessment is efficient, adequate cervical visualization is not always achievable, and transvaginal (TV) imaging may be required. Aim(s): To evaluate whether the implementation of a multidisciplinary radiologist-sonographer quality assurance (QA) pathway improved compliance with institutional cervical assessment standards. Method(s): This multiphase quality improvement study included baseline audit data from sampled audit periods in 2023-2024, a prospective intervention conducted between March and May 2025, and a 6-month post-intervention follow-up. The intervention incorporated targeted sonographer education and a radiologist-supported QA workflow using a dedicated RIS/PACS "QA Cervix" folder. Flagged TA cervical assessments were independently reviewed by two senior sonographers against predefined acceptability criteria. Outcomes were compared with a 2024 audit using the same criteria. Result(s): A total of 562 morphology scans were performed. TA cervical assessments that failed technical adequacy decreased from 23.9% (109/455) in 2024 to 14.0% (79/562) during the pilot (p < 0.001). TV assessment rates increased from 29.2% (133/455) to 54.4% (306/562) (p < 0.001), approaching published recommendations. A total of 14 short cervix cases were identified, enabling timely clinical management. Conclusion(s): A radiologist-led QA pathway supported by targeted education reduced TA failed technical adequacy and increased appropriate escalation to TV assessment. This multidisciplinary model provides a practical governance framework to support consistent cervical assessment during routine morphology ultrasound.Copyright © 2026 The Author(s). Sonography published by John Wiley & Sons Australia, Ltd on behalf of Australasian Sonographers Association.