Learning curve for ultrasound-guided external cephalic version without anesthesia in full-term and near-term pregnancies
10.3760/cma.j.cn113903-20211220-01051
- VernacularTitle:超声引导非麻醉下足月及近足月臀位外倒转术的学习曲线
- Author:
Bai JIN
1
;
Lenan LIU
;
Yuan ZHAN
;
Yin YIN
;
Chenyan GUO
;
Min ZHANG
;
Guoying ZHANG
Author Information
1. 南京医科大学第一附属医院 江苏省人民医院产科，南京 210029
- Keywords:
External cephalic version;
Breech presentation;
Success rate;
Parity;
Learning curve;
Cumulative sum analysis
- From:
Chinese Journal of Perinatal Medicine
2022;25(6):455-460
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the effects of physician skills on the success rate of the external cephalic version (ECV) and investigate the learning curve for ECV.Methods:A retrospective study of 97 pregnant women who underwent ECV at the First Affiliated Hospital of Nanjing Medical University from March 2019 to August 2021 was performed. Patients were divided into multipara and primipara groups. The success rate of ECV and morbidity were compared between the two groups, and the learning curve for ECV was evaluated using cumulative sum analysis (CUSUM).Results:(1) Patients in the multipara group were older than those in the primipara group [(33.0±3.4) vs (29.2±3.0) years, t=－5.57, P<0.001]. No significant difference was found in other baseline data between the two groups. (2) The overall ECV success rate was 61.9% (60/97), and a higher success rate was observed in the multipara group [93.3% (28/30) vs 47.8% (32/67), χ 2=18.24, P<0.001]. Fetal heart rate deceleration (5.2%, 5/97), vaginal bleeding (1.0%, 1/97), premature rupture of membranes (1.0%, 1/97), and fetal distress (1.0%, 1/97) were the main complications. (3) The CUSUM analysis showed that it needed 53 primiparas for a physician to obtain a 50% consistent success rate ( R2=0.91, H=－3.27, Y=52.16) and seven multiparas to achieve a 70% consistent success rate ( R2=0.99, H=－1.635, Y=6.60). Conclusions:Parity and operator skills have a significant influence on the success of ECV. A physician with standardized training will manage non-anesthesia ECV skillfully in full-term and near-term pregnancies after practice on 50 primiparae or approximately ten multiparae. It is recommended to start with the multiparae for learning ECV to build up confidence and promote the implementation of ECV.
