Part 1- Education and training
This was a prospective observational study which took place in Norway
from 15th February to 15th August
2017. All delivery units with more than 500 deliveries were invited to
participate. To ensure an equally distributed recruitment throughout the
whole country, three smaller units located in Northern Norway were
invited as well. All but one of the 26 invited units chose to
participate in the study. One participating unit did not complete the
entire study period due to a lack of local resource although they
supported the concept of the project.
The first part of the study consisted of teaching and certification of
local collaborators. All participating units appointed 1-3 local
collaborators who met for a one-day seminar. At this meeting the
philosophy and scientific methodology of the ICSCS was presented. Based
on a totally inclusive and mutually exclusive classification one out of
seven subcategories could be chosen to classify the intrapartum CS
(Fig.1, Supplement 1). For the purpose of classification, the fetal
status, the dynamics of labour, the use of oxytocin (either for
acceleration or for induction) combined with and frequency of uterine
contractions (cardiotocograph) was required. The participants in the
study discussed the ICSCS in small groups based on a set of ten cases,
followed by a joint presentation reviewing the cases using the study
form. The seminar finished with a certification test for all the
participants including the classification of ten cases of intrapartum
CS, not known to the collaborators beforehand. The level of agreement
for each collaborator against the correct classification was estimated
by Cohen´s kappa test.