An Intrapartum Cesarean Delivery Classification System - a prospective eighteen year longitudinal cohort study.

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Health Services Research

Background:

• No universal classification system exists for cesarean delivery indications.
• Standardized systems are crucial for both intrapartum and prelabor cesarean deliveries.
• This study evaluates a specific intrapartum classification system.

Purpose of the Study:

• To describe the value of a standardized and comprehensive Intrapartum Cesarean Delivery Classification System (ICDCS).
• To analyze the ICDCS's interaction with other labor and delivery events and outcomes.
• To assess the system's utility within the Ten Group Classification System framework.

Main Methods:

• Prospective cohort study conducted over 18 years (2005-2022) at an Irish tertiary maternity center.
• Included single cephalic pregnancies at ≥37 weeks' gestation, categorized into six groups based on parity and labor induction status.
• Cesarean deliveries were classified using the ICDCS and analyzed alongside labor events and outcomes.

Main Results:

• Over 18 years, 151,284 deliveries occurred, with a 24.5% cesarean delivery rate.
• The ICDCS demonstrated consistent subgroup indications and differences between the Ten Group Classification System groups.
• Significant increases in cesarean rates were observed in specific groups, alongside rises in postpartum hemorrhage and operative vaginal deliveries.

Conclusions:

• The ICDCS has been successfully utilized for 18 years.
• Integrating ICDCS with the Ten Group Classification System provides a granular understanding of labor events and outcomes.
• This combined approach allows for potential improvements in intrapartum guidelines and clinical practice.