Objective: To identify which risk communication graphics are easiest to understand when communicating risks surrounding birth; and investigate the effect of numeracy and health literacy on understanding. Design: Online survey with randomised content Setting: UK Population: Women and their partners, healthcare professionals and stakeholders in the UK. Methods: Seven candidate graphics (’10-person’, ‘100-person’, ’10-circle’, ‘100-circle’ icon arrays, ‘bar charts’, ‘pie charts’ and ‘words’) were co-produced with a patient and public involvement group. These were used to develop seven online surveys. Participants were recruited using social media and adverts in participating hospitals. Each participant was randomised to see one of seven surveys, the survey questions remained the same, the graphics varied. Data were collected on risk perception, perceived ease of understanding and preference, alongside demographic factors, numeracy skills and health literacy. Main outcome measures: Objective comprehension and subjective preference for graphics. Results: There were 858 participants, 771 women/partners/parents and 87 healthcare professionals and stakeholders. 70% of participants answered all four numeracy questions correctly, and respondents reported high health literacy (76.5% can understand health material, 72.8% were comfortable completing medical forms). All graphics were understood; however, the ‘100-person’ icon array elicited the best score when comparing two risks (mean score 97.5% compared to next best performing graphic 95.8%), 41% believed it was the easiest to understand and 36% selected it as the preferred graphic. Conclusions: All graphics are well understood. The ‘100-person’ icon array scored best in terms of risk comparison and participant preference. Using this graphic may support high-quality communication of risk in maternity care.

Background: There is a growing body of evidence suggesting that endocervical crypt involvement by high-grade cervical intraepithelial neoplasia (CIN) may represent a risk factor for disease recurrence after cervical treatment. Objectives: To provide a systematic review and meta-analysis on whether endocervical crypt involvement by high-grade CIN on the excised cervical specimen is associated with high-grade histopathological recurrence during the follow-up of women after cervical excisional treatment. Search Strategy: We searched the Medline, Scopus, Central and Clinical Trials.gov databases from inception till June 2021. Selection Criteria: Studies that reported on women with a single cervical treatment with any method of excision for CIN2 or CIN3 lesion, negative excision margins and whose recurrence was defined histopathologically were included. Data Collection and Analysis: Two reviewers independently evaluated study eligibility. We used the fixed effects model for meta-analysis. Main Results: There were 4 eligible studies included in the present systematic review that evaluated 1088 women treated with either large loop excision of the transformation zone (LLETZ) or with cold knife conization (CKC). The between study heterogeneity was not significant. We found no significant association of endocervical crypt involvement by CIN2-3 with high-grade histopathological recurrence at follow-up after cervical excision (OR:1.93; 95%CI:0.51-3.35). The subgroup analysis of women with LLETZ cervical excision showed again no significant association with high-grade histopathological recurrence at follow-up (OR:2.00; 95%CI:0.26-3.74). Conclusions: Endocervical crypt involvement by high-grade CIN does not seem to be a risk factor for high-grade histopathological recurrence after cervical excision with negative excision margins.