Conclusion
High level classification of intrapartum CS using totally inclusive but also mutually exclusive objective criteria is useful for interpretation of clinical practice. Detailed and more subjective clinical indications are more useful used within the ICSCS and within the overarching structure of the TGCS.
We successfully tested a ICSCS in a prospective nationwide study. The system can be easily taught, and we recommend including it as part of routine perinatal data collection. It may become a valuable objective tool for analyzing and improving the management of labour.
Acknowledgement
We thank the Norwegian Medical Association (Anne Sofie Torp and Audun Fredriksen) for generous financial and administrative support. The professional assistance from the staff at the Medical Birth Registry of Norway was a guarantee for successful data collection and processing. Finally, we are grateful for the tremendous efforts from the participating units: Sørlandet Hospital Arendal (Karin Lillejord Kristoffersen, Ole Georg Torjusen), Haukeland University HospitalBergen (Anne Tandberg), Norland Hospital Bodø (Hiba Mohammed, Hild Mæland), Bærum Hospital (Helene Heide),Drammen Hospital (Angeline Styve Einarsen, Anne Molne Kjøllesdal), Innlandet Hospital Elverum (Hanne Maartmann), Østfold Hospital Fredrikstad (Britt Helene Skaar Udnæs, Guri Kristine Vognild), Førde Hospital (Mette Kristine Hjertaas, Randi Mette Sygard Steen,), Innlandet Hospital Gjøvik (Wenche Hauso, Marthe Ulven), Hammerfest Hospital (Ingjerd Røeggen),Haugesund Hospital (Thomas Hahn, Kristin Urnes), Ringerike Hospital Hønefoss (Anne Grønnevik, Silje Skaar Moe, Hege Kristin Navrud), Sørlandet Hospital Kristiansand (Bente Maltby),Levanger Hospital (Marit Heggdal), Innlandet HospitalLillehammer (Ann Hilde Berg, Anna Danielsson), Akershus University Hospital Lørenskog (Eli Aaby, Helene Normann Furnes, Nicola Janowitz, Gro Merete Overrein, Eva Ringnes, Sylvia Rugaas),Namsos Hospital (Lars Derås, Sonny Anitha Wibstad), OsloUniversity Hospital Ullevål (Kristin Bøhn, Linda Björk Helgadottir, Thorbjørn Brook Steen, Marit Øgaard), Oslo University Hospital Rikshospitalet (Anne-Sofie Letting, Ingvil Krarup Sørbye), Telemark Hospital Skien (Stig Alexander Hill, Kevin Sunde Oppegård), St Olav Hospital Trondheim (Kirsti Myklestad, Tone Selmer-Olsen, Britt Sissel Aarseth Vedvik), Vestfold Hospital Tønsberg (Hårek Augestad Lysberg, Linn Tokheim Nistov), Nordland HospitalVesterålen (Kristen Olav Lind), Ålesund Hospital (Sissel Hjelle, Lena Hüttner).
Disclosure of interests: None declared.
Contribution to authorship: JK initiated the project and national data collection, performed the data analysis, and drafted the manuscript. MR gave support in teaching the ICSCS to the collaborators from participating units and participated in the interpretation of data and revision of the manuscript. Apart from their role as local project collaborators FM, JR and CT participated in data interpretation and revision of the manuscript.
Details of ethics approval: The study was approved by the Research Ethics Committee (REK Nord 2018/1682-3). Data collection to the Medical Birth Registry of Norway is mandatory and does not require consent form the women.
Funding: The study received funding from the Norwegian Medical Association, fund of quality improvement and patient safety.
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