Cervical Length Education & Review
Bringing Patient Safety to the Forefront...
Efficacy of Transvaginal Ultrasound Cervical Length Education via CLEAR in Improving Cervical Length Imaging Among OB/GYN Residents

Study Summary


Transvaginal ultrasound cervical length (TVU CL) imaging is becoming increasingly utilized for the prediction and prevention of preterm birth. In the outpatient setting it is used to screen both low and high risk women for preterm birth and in the inpatient setting it is used to triage women presenting with complaints of preterm labor. However, there is no required standard training to ensure quality of cervical length imaging, which can impact the management of a patient from the decision to give antenatal corticosteroids, initiate progesterone therapy, or recommend a cerclage.

Two prior small studies (Vahanian 2015, Chory 2016) have examined resident cervical length imaging education. One study used an institution specific educational module, another used an author designed curriculum. Both studies found an improvement in post-test/post training image quality, however both studies were small (15-20 total participants), used institution specific educational curriculum, and had no long term follow up.

The Cervical Length Education and Review (CLEAR) program was developed by the Perinatal Quality Foundation, a sister organization to the Society for Maternal Fetal Medicine, to ensure that persons performing TVU CL measurement in pregnancy were properly trained and adhered to standardized criteria for documentation of TVU cervical length ( This provides a standard educational program and quality criteria for transvaginal cervical length imaging that is accessible to all residents.


The purpose of this study is to determine the efficacy of transvaginal ultrasound cervical length education via (CLEAR) in improving cervical length imaging among ob/gyn residents.

Study Design

This is a prospective observational cohort study. Ob/Gyn interns at Thomas Jefferson University Hospital will be invited to participate. Prior to any formal training they will each submit 5 images of TVU CL (done at gestational age 16-32 weeks) and undergo a pre-test, they will then undergo the training, and then complete the post-test and submit an additional 5 images. Participants will also be asked to complete a brief survey before and after CLEAR training.

In order for a candidate's batch of images to pass, all images must meet at least 7 of the 9 criteria assessed (Table 1), the overall batch score needs to be ≥80% (i.e. if 5 images are submitted, a minimum score of 36 of a possible 45 must be achieved), correct caliper placement must be met for all images, and the same criterion cannot be consistently missed on all images.


This study will be offered to ob/gyn residents at participating programs in the United States. Their images will only be included in results if submit a batch (5) of images before AND after the education. Images submitted by study participants will be labeled with a study ID and no participant or patient identifying information will be associated with any specific image, response, or result.

The only exclusion criteria is prior completion of the CLEAR program.

Participants will receive complementary CLEAR training.