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Effect of learning curve on the outcome of external cephalic version
1Department of Obstetrics and Gynaecology, Johor Specialist Hospital, Johor Bahru, Malaysia.
Aim:
The aim of this study was to find out the effect of learning curve on the outcome of external cephalic version (ECV) at term, using tocolytics. The effect of various factors affecting the outcome of ECV was also studied in relation to the learning curve.
Methods:
This is a prospective longitudinal observational study of 80 consecutive cases of ECV. They were analysed in relation to outcome, parity, type of breech, placental site and birth weight. The cases were divided consecutively into 4 groups of 20 cases each, in order to analyse the effect of learning curve.
Results:
The learning curve for ECV is very sharp. The success rate of external cephalic version plateau after the first 20 cases from 45% to about 60%. Only parity and type of breech have a significant effect on the outcome. The success rate is lower for primipara and non-flexed breech. This negative effect is strongest in the first 20 cases and again plateaus after the first 20 cases. The high success rate of multipara and primipara flexed breech is obtained even in the first 20 cases and does not improve with further experience.
Conclusions:
The learning curve for ECV is sharp and plateaus after the first 20 cases. Outcome of ECV for patients with favourable factors such as multiparity and flexed breech is not affected by learning curve.