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Updated: Jul 20, 2026

External Cephalic Version: Is it an Effective and Safe Procedure?
Published on: June 6, 2020
The effect of learning curve on the outcome of caesarean section
W Y Fok1, L Y S Chan, T K H Chung
1Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. angelfok@cuhk.edu.hk
Objective:
To evaluate the operative outcomes when trainees first perform caesarean sections independently.
Design:
A retrospective study in a tertiary obstetric unit.
Population:
Five hundred caesarean sections, which represented the first 50 caesarean sections performed independently by each of ten trainees, were studied.
Methods:
The effect of learning curve on outcome was analysed.
Main Outcome Measures:
Total operative time, incision-to-delivery interval, operative blood loss, Apgar score, cord arterial pH, incidence of neonatal intensive care unit admission, postoperative complication rates and duration of hospitalisation.
Results:
The mean operative time for the first five cases by trainees was 52.2 +/- 11.4 minutes. It progressively decreased and reached 39.6 +/- 8.4 minutes for the 46th to 50th cases. The operative time was significantly longer in the first 15 caesarean sections (P < 0.05). Moreover, the incision-to-delivery interval was also longer during the first five cases (P= 0.02). Besides the time of the operation, the trend for operative blood loss stabilised after the first ten caesarean sections (P < 0.05). Otherwise, there were no significant differences among other outcome variables.
Conclusion:
This study shows that trainees need to perform 10-15 caesarean sections before their skills become more proficient. Senior obstetricians may need to provide guidance to the trainees during their first independent 15 caesarean sections.
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