This presentation on Caesarean Scar Niches and Uterine Synechiae will discuss why some women develop a niche, and what the potential consequences can be (including Caesarean Scar Pregnancy, Placenta Accreta Spectrium, subfertility and irregular menstrual bleeding). It will also discuss Uterine Synechiae, or Asherman's Syndrome. There will be 2D and 3D images as well as video clips of 'As Live' ultrasound examinations.

Introduction: Postmenopausal bleeding is a critical symptom of potential endometrial cancer, requiring timely diagnosis and support. As a senior clinical nurse, I perform ultrasound scans to assess the endometrium, enabling early diagnosis of cancer and referral for treatment. I have also observed the need to optimise clinicians’ time for diagnosing and treating patients while ensuring comprehensive support for individuals and their families.
Methods: In collaboration with Macmillan, a leading cancer charity, we established a streamlined pathway to introduce patient support services early in the diagnostic process. This involves referring patients to Macmillan immediately upon diagnosis, allowing simultaneous clinical evaluation and support assessment.
Results: This approach has demonstrated improved efficiency in clinical workflows, with clinicians focusing more on diagnostic and therapeutic duties. Patients benefit from early and robust psychosocial and practical support, provided free of charge. Families also gain access to resources that aid in navigating the cancer journey.
Conclusion: Integrating Macmillan services early in the patient pathway fosters a collaborative care model that enhances patient and family support while reducing clinician workload. This model addresses both clinical and emotional needs, ensuring a holistic approach to cancer care.

Take-Home Message
Early collaboration with cancer support organisations like Macmillan improves patient outcomes and allows clinicians to dedicate more time to their primary duties. This integrated approach highlights the importance of teamwork and resource utilisation in delivering high-quality care for endometrial cancer patients.

Introduction: Endometriosis affects 1 in 10 people assigned female at birth in the reproductive age group. It is often a progressive disease resulting in pain and reduced fertility. A transition has occurred where a diagnosis of endometriosis is increasingly made by ultrasound rather than diagnostic laparoscopy, this being the case it is imperative that we develop ultrasound skills that allow us to detect endometriosis in all its various forms and appearances.
Method: Diagnosing for endometriosis involves a thorough patient history and a good understanding of the various appearances of endometriosis. This requires an appreciation of the different phenotypes of endometriosis as well as the typical appearances of endometriosis on different parts of the pelvic anatomy.
Results: Endometriosis has a variety of appearances often dependent on the organs that are involved, this presentation will detail the typical appearances that characterises endometriosis on the various pelvic organs.
Conclusion: To perform an endometriosis ultrasound, it is essential that we know the various appearances and forms of endometriosis. These appearances my differ depending on which pelvic organs are affected and a detailed knowledge will aid in making the making the diagnosis of endometriosis.
Take home message: Understanding the ultrasound appearance of endometriosis and how that can differ between various pelvic organs can increase our confidence and ability to diagnose this progressive and debilitating disease.

Introduction: Patent canal of Nuck is described as failure of the process vaginalis (invaginated peritoneum within the inguinal canal portion of the Process Vaginalis) to obliterate during the 1st year life. Patent canal of Nuck in patients assigned female at birth, can result in an inguinal hernia which may contain fluid, fat, ovary, tube, uterus or bowel and rarely the bladder. In the female patient it is the equivalent to the patent process vaginalis in the male. Presentation, usually in the paediatric age group, is an asymptomatic groin or labial swelling with right sided patency more common than left. Patency can result in organ incarceration or ovarian torsion and may be associated with syndromes and Mullerian agenesis.
Method: Interrogation of the patient’s lump and groin using B mode should be performed with a high frequency (HF) linear transducer to exclude herniated organs and incarceration and colour Doppler to exclude torsion and assess relationship to the inferior epigastric veins. Compression should be employed to assess reducibility.
The pelvis and kidneys should be assessed for organ position and to exclude congenitally absent organs using a HF curvy linear transducer.
Results: Ultrasound Appearance-A patent canal presents as a mobile/immobile cystic or solid mass in the labia or groin lateral to inferior epigastric veins. Contralateral pelvic organs are often situated closer to the affected side.

Conclusion/Take home Message:
Assessment by ultrasound for canal of Nuck patency is the gold standard. Health professionals need to be aware of this rare entity in female patients.