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.