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Related Experiment Video

Updated: Feb 25, 2026

External Cephalic Version: Is it an Effective and Safe Procedure?
08:49

External Cephalic Version: Is it an Effective and Safe Procedure?

Published on: June 6, 2020

15.9K

Evaluation of the learning curve for external cephalic version using cumulative sum analysis.

So Yun Kim1, Jung Yeol Han1, Eun Hye Chang1

  • 1Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea.

Obstetrics & Gynecology Science
|August 10, 2017
PubMed
Summary

This study used learning curve-cumulative sum (LC-CUSUM) analysis to evaluate the learning curve for external cephalic version (ECV). Physicians can achieve success in multipara cases first, then nullipara cases with experience.

Keywords:
Amniotic fluidBreech presentationLearning curveVersion, fetal

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Area of Science:

  • Obstetrics and Gynecology
  • Medical Education
  • Perinatal Medicine

Background:

  • External cephalic version (ECV) is a procedure to turn a fetus from a breech to a cephalic presentation.
  • Evaluating the learning curve for ECV is crucial for improving procedural success rates and patient safety.
  • The learning curve-cumulative sum (LC-CUSUM) analysis is a statistical method used to assess proficiency in medical procedures.

Purpose of the Study:

  • To evaluate the learning curve for performing external cephalic version (ECV) using LC-CUSUM analysis.
  • To determine the number of cases required for a physician to achieve proficiency in ECV for both nulliparous and multiparous patients.

Main Methods:

  • Retrospective analysis of 290 consecutive ECV cases performed between October 2013 and March 2017.
  • Application of LC-CUSUM analysis to assess the learning curve for ECV in nulliparous and multiparous (over para 1) groups.
  • Assumption of 50% and 70% success rates for ECV procedures to define proficiency thresholds.

Main Results:

  • The overall ECV success rate was 64.8%. Nulliparous success rate was 56.2%, and multiparous success rate was 78.6%.
  • LC-CUSUM analysis indicated that 57 nulliparous cases are needed for a consistent 50% success rate, and 130 cases for a 70% success rate.
  • Fewer cases (8-10) were required for multiparous patients to achieve expected success rates of 50% and 70%.

Conclusions:

  • Physicians can achieve success in ECV for multiparous patients with initial experience, and subsequently gain proficiency in nulliparous cases.
  • Further research involving multiple practitioners is recommended to establish standardized learning curve guidelines for ECV.
  • LC-CUSUM analysis provides a valuable tool for objectively assessing and defining proficiency in ECV procedures.