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KMID : 0358420170600040343
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Korean Journal of Obstetrics and Gynecology
2017 Volume.60 No. 4 p.343 ~ p.349
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Evaluation of the learning curve for external cephalic version using cumulative sum analysis
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Kim So-Yun
Han Jung-Yeol
Chang Eun-Hye
Kwak Dong-Wook
Ahn Hyun-Kyung
Ryu Hyun-Mi
Kim Moon-Young
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Abstract
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Objective: We evaluated the learning curve for external cephalic version (ECV) using learning curve-cumulative sum (LC-CUSUM) analysis.
Methods: This was a retrospective study involving 290 consecutive cases between October 2013 and March 2017. We evaluated the learning curve for ECV on nulli and over para 1 group using LC-CUSUM analysis on the assumption that 50% and 70% of ECV procedures succeeded by description a trend-line of quadratic function with reliable R2 values.
Results: The overall success rate for ECV was 64.8% (188/290), while the success rate for nullipara and over para 1 groups was 56.2% (100/178) and 78.6% (88/112), respectively. ‘H’ value, that the actual failure rate does not differ from the acceptable failure rate, was ?3.27 and ?1.635 when considering ECV success rates of 50% and 70%, respectively. Consequently, in order to obtain a consistent 50% success rate, we would require 57 nullipara cases, and in order to obtain a consistent 70% success rate, we would require 130 nullipara cases. In contrast, 8 to 10 over para 1 cases would be required for an expected success rate of 50% and 70% on over para 1 group.
Conclusion: Even a relatively inexperienced physician can experience success with multipara and after accumulating experience, they will manage nullipara cases. Further research is required for LC-CUSUM involving several practitioners instead of a single practitioner. This will lead to the gradual implementation of standard learning curve guidelines for ECV.
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KEYWORD
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Amniotic fluid, Breech presentation, Learning curve, Version, fetal
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