Classification of intrapartum cesarean sections: a prospective national
study in Norway (Nor-Why-Cesarean study)
Abstract
Objective: To validate an intrapartum Cesarean Section
Classification System (ICSCS). Design: Nationwide prospective
observational study. Setting: Twenty-five Norwegian maternity
units Population or Sample: Singleton cephalic pregnancies with
spontaneous or induced labour at ≥ 37 weeks gestation delivering
February-August 2017. Methods:. After training of all
collaborators, Cesarean section (CS) after spontaneous or induced labour
were classified based on fetal status, dynamic progress in labour, use
of oxytocin, frequency of contractions and linked to denominator data
collected and centralized by the Norwegian Medical Birth Registry.
Main Outcome Measures: Cohens kappa as measure of agreement for
correct application of the classification. Prevalence of the different
groups using the ICSCS within the Ten Group Classification System
(Robson groups). Results: Of 49 trained experts, 40 (82%) had
a κ >0.6 indicating good or very good level of agreement
when the classification was applied. A total of 1425 CS were classified:
CS classified as fetal indication (no oxytocin) was more common in
induced (Group 2a, 4a, 5b) compared to spontaneous labours (Group 1, 3,
5a). CS classified as dystocia related to inefficient uterine action and
poor response to oxytocin occurred more often in induced as compared to
spontaneous labours. The prevalence of CS classified as dystocia with
efficient uterine action (malposition or cephalopelvic disproportion)
was low in all Robson groups. Conclusions: The ICSCS was
successfully validated in a national study. It may become a valuable
objective tool for analyzing the management of labour and explaining
differences in the prevalence of CS between different groups of women.