Introduction There is limited access to life-saving antenatal ultrasound in rural and low-resource settings largely due to shortages in skilled staff. Studies have shown healthcare practitioners can be upskilled in PoCUS through focused training, offering a viable solution to this deficit. However, standards for training and competency assessment are unclear and regulation surrounding practice is lacking. We aimed to review published literature examining antenatal PoCUS training programs, comparing teaching approaches and study methodologies. Methods A search of electronic databases EMBASE, MEDLINE and Google Scholar was conducted. Original research articles evaluating antenatal PoCUS training of healthcare professionals worldwide were identified for analysis. Articles with limited detail on the PoCUS training intervention and those describing comprehensive diagnostic training programs were excluded. Evaluations were compared against the Kirkpatrick Evaluation Framework (KEF). Results Twenty-seven studies were included from an initial search result of 484 articles. There was considerable heterogeneity between the PoCUS training programs described. Course duration ranged from 3 hours to 2 years, with 11 of the 27 studies delivering obstetric-exclusive content. 44% trained multidisciplinary groups of health professionals. Long-term follow-up training and skills assessments were lacking in over half of the reviewed studies. Study quality and reporting detail varied, but overall beneficial outcomes were reported with 3/4s of the studies reaching upper KEF levels 3 and 4. Conclusion PoCUS performed by upskilled healthcare professionals offers an attractive solution to the problem of inequitable access to antenatal ultrasound. A review of available literature highlighted a paucity of comparable high-quality studies needed to establish a stronger evidence base for antenatal PoCUS, and a need to standardise training and competency assessment. This review may inform educators, researchers and policy-makers on existing training formats and methodologies to assist in establishing best practice antenatal PoCUS training methods for safe service delivery by remote healthcare professionals.

Results: It was observed that, patients with CHA2DS2-VASc-HS score > 4 had more adverse in-hospital outcomes than CHA2DS2-VASc-HS score 4 (20% vs. 3.3%, p = 0.01). Group I patients developed cardiogenic shock 10%, heart failure 4%, recurrent ischemia 11.7%, significant arrhythmia 1.7% and death 1.7% than group II patients (1.7%, 3.3%, 3.3%, 0% and 0% respectively). By risk measurement, CHA2DS2-VASc-HS score > 4 emerged as a risk factor for developing adverse in-hospital outcome (Relative risk = 6). Conclusion: NSTEMI patients with high CHA2DS2-VASc-HS score have more adverse in-hospital outcomes. This score, which involves only clinical parameters, can be used as a predictor of outcomes in this group of patients.

Background There is limited access to life-saving antenatal ultrasound in low-resource rural and remote settings worldwide, including Australia, mainly due to shortages in skilled staff. Point-of-care ultrasound (PoCUS) offers a viable solution to this service deficit, however, rural clinicians face many barriers accessing training and professional development critical to advancing their clinical practice. Standards for PoCUS training and competency assessment are unclear. Regulation is lacking globally, allowing untrained and inexperienced clinicians to practice PoCUS clinically. Methods This prospective single cohort study aimed to evaluate antenatal PoCUS training workshops for General Practitioners (GPs) and Midwives/Nurses (M/Ns) from rural/remote Australia, assessing the impact of the training on trainees’ knowledge, confidence and translation of PoCUS into clinical practice. Two-day antenatal ultrasound workshops were delivered at the University of South Australia (UniSA) in 2018 and 2019 to 41 rural/remote clinicians . The training was designed and evaluated using the New world Kirkpatrick Evaluation Framework. Sixteen GPs and 25 M/Ns with mixed prior ultrasound experience were funded to attend. The course consisted of lectures interspaced with hands-on training sessions using high-fidelity simulators and live pregnant models. Pre- and post-knowledge assessments were performed. Post-workshop evaluation and follow-up surveys (3- and 6-month post-training) assessed the workshops and changes to trainees’ clinical practice. A 2-day follow-up training session was conducted 12 months after the workshops for 9 trainees. Results Pre/post knowledge testing demonstrated a 22% mean score improvement (95% CI 17.1 to 27.8, P < 0.0001). At 6 months, 62% of trainees were performing PoCUS that had assisted in patient management and clinical diagnosis, and 46% reported earlier diagnosis and changes to patient management. 74% of trainees had increased scanning frequency and 93% reported improved scanning confidence. Conclusion This study demonstrated intensive 2-day workshops can equip clinicians with valuable antenatal PoCUS skills, offering a viable solution to assist in the assessment and management of pregnant women in the rural/resource-poor setting where access to ultrasound services is limited or non-existent. Geographical isolation and lack of onsite specialist supervision poses an ongoing challenge to the continuing professional development of remote trainees and the implementation of PoCUS.

Objectives: The objective of this research was to evaluate the effectiveness of teaching, explore experiences of clinicians and examine the impact of POCUS in clinical practice using KEF. Methods: Two intensive 2-day ultrasound training small group workshops incorporating lectures and hands-on sessions involving high fidelity simulators and live pregnant models, endorsed by ASUM and ISUOG were conducted for 12 GPs and 13 midwives. Participants maintained a record of frequency of use, ultrasound applications, change in clinical practice, changes in behaviour of clinical management and in antenatal patients such as modifications in lifestyle as a result of the POCUS scan.The KEF Levels 1 to 4 were used to appraise the efficacy of POCUS training, which included assessment of immediate reactions after training (Level 1), learning after training (Level 2), behavioural changes after training (Level 3) and results and impact on clinical practice after training (Level 4) using specifically designed surveys. Results: KEF Level 1 surveys demonstrated that the participants found the training very useful. Details and data for KEF Levels 2, 3 and 4 surveys will be presented. Advantages, limitations, barriers and challenges of POCUS implementation in clinical practice will be presented. Concrete tips for use of KEF in evaluating efficacy of ultrasound training programs will be discussed. Conclusions: Provision of antenatal POCUS training appears to benefit clinical practice in remote resource-poor settings in remote South Australia. KEF appears to be useful in evaluation of POCUS training. OP04.03Manual versus automated segmentation for the computed assessment of the fetal face from ultrasound scans: preliminary results from a pilot study

affect the physiological changes inside the uterus and result in poor maternal blood flow to the fetoplacental unit. Consequently, this reduces oxygen and nutrient delivery to the fetus which can cause ischemia reperfusion injury and vascular obstetrical complications. Three-dimensional (3D) vaginal power Doppler (3DVPD) is a quantitative assessment of blood circulation. Our objective was to study if 3DVPD applied on endometrium and myometrium around gestational sac could be affected by life style in intracytoplasmic sperm injection (ICSI) patients. Methods: This was a prospective observational study at AL HADI IVF CENTER, 123 singleton pregnancies conceived after Intra-cytoplasmic Sperm Injection (ICSI) procedure, between January 2019 and June 2020 were recruited. At 3 week of gestation, 3D vaginal power Doppler was applied by the same operator around the gestational sacs to calculate 3 indices: vascular index (VI) flow index (FI) and vascular flow index (VFI). The indices are calculated by the ultrasound built-in computer using specially developed software (VOCAL). Patients were asked to fill a questionnaire concerning smoking, caffeine consumption, height and weight and sport exercise. Results: No correlation was found between actual smoking, cumulative previous exposure to smoking or caffeine consumption with any of 3DVPD indices. Concerning sport exercises, no difference between any of the 3DVPD parameters and the number of daily hours of exercise. BMI was divided into 5 categories, none of them was associated with any indices of 3DVPD. Conclusions: It is the first study to assess the impact of life style parameters on the materno-fetal vascularisation using the 3D vaginal power Doppler. None of the variable tested (obesity, smoking, caffeine consumption and sport) was identify as a determinant of 3DVPD indices at 5 weeks of gestation. A study should be conducted to analyse this effect at later stages. VP02.09Enhanced myometrial vascularity: a hidden entity