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Classification of caesarean sections in spontaneously labouring, single cephalic, nulliparous women at greater then 36 weeks (SCNT)

      Objective

      SCNT is the single most important group in the management of women in labour. There is greater variation in the caesarean section rate in SCNT then in any other group of women. The group is a significant contributor to the overall caesarean section (CS) rate. We present a classification system which allows the objective comparison of the indications of CSs in this group of women.

      Study design

      The classification system defines fetal distress and dystocia as the only 2 groups under which CSs could be classified. Fetal distress includes only women not treated with oxytocin. Dystocia is subdivided into 5 groups. The first 4 are all defined as ineffecient uterine action, but subdivided into poor response (but full dose of oxytocin)(DPR), inability to treat (due to overcontracting or malpresentation)(DITTOCMP) inability to treat (due to fetal intolerance)(DITTFI) and lastly cases where no oxytocin has been used DNO. The fifth sub group of dystocia, where inefficient uterine action has been excluded, consists of cases of cephalo pelvic disproportion or persistent occipito posterior position (DCPDPOP). All these groups are mutually exclusive and totally inclusive. The classification was applied over a 6 month period in a unit who has practised active management of labour (AML) for 40 years. All consecutive SNCT irrespective of any other medical or obstetric history were included in the analysis.

      Results

      The overall CS rate in SCNT was 7%. Even in a unit that practises AML inefficient uterine action remains the most common reason for caesarean section. The most common subgroup was DITTOCMP. True cephalo pelvic disproportion is rare. No woman was delivered by CS for dystocia without being treated with oxytocin.

      Conclusion

      A standard classification system, if used, will allow different units with different management protocols to compare in an objective manner the indications for caesarean sections in SCNT.
      Tabled 1Classification of CSs in spontaneous labour 70/994 (7.0%)
      FDDPRDITTOCMPDITTFIDCPDPOPDNO
      n = 12n = 15n = 25n = 11n = 7n = 0