The effect of learning curve on the outcome of caesarean section
Article first published online: 15 SEP 2006
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 113, Issue 11, pages 1259–1263, November 2006
How to Cite
Fok, W., Chan, L. and Chung, T. (2006), The effect of learning curve on the outcome of caesarean section. BJOG: An International Journal of Obstetrics & Gynaecology, 113: 1259–1263. doi: 10.1111/j.1471-0528.2006.01060.x
- Issue published online: 15 SEP 2006
- Article first published online: 15 SEP 2006
- Accepted 25 July 2006. Published OnlineEarly 18 September 2006.
- Caesarean section;
- learning curve;
- operative outcome;
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.