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The Intrapartum Cesarean Delivery Classification System (ICDCS) helps to identify consistent clinical trends in cesarean indications, supporting improved understanding and refinement of intrapartum care practices.
A prospective longitudinal cohort study from the National Maternity Hospital in Ireland has highlighted the usefulness of a structured approach to classifying cesarean deliveries that occur during labor. Over an 18-year period, Michael Robson and other researchers tracked cesarean delivery trends using a system known as the Intrapartum Cesarean Delivery Classification System (ICDCS). Their goal was to bring more clarity to the reasons behind cesareans carried out after labor begins, especially since there is currently no universally accepted way to classify them.
When used alongside the widely known Ten Group Classification System (TGCS), the ICDCS offered deeper insights into how labor progressed and why certain cesareans were executed. The study followed 151,284 women with single, head-down pregnancies at 37 weeks or later who went into either spontaneous or induced labor. The focus was on 6 specific TGCS groups, including first-time mothers and women with previous cesareans. Among these groups, a total of 13,124 intrapartum cesareans were classified via the ICDCS, offering a rich dataset to examine trends and outcomes.
Throughout the study period, the hospital's overall cesarean rate was 24.5%. Notably, cesarean rates rose markedly in first-time mothers. In Group 1 (spontaneous labor), the rate went up from 7.4% to 11.9%, while in Group 2a (induced labor), it escalated from 27.9% to 38.3%. These changes were statistically significant. Meanwhile, cesarean rates in other groups—such as multiparous women and those with a history of cesarean—remained mostly stable. The authors also compared two specific timeframes within Group 1 (2010–2012 vs. 2020–2022) to see how indications and outcomes had shifted.
The overall cesarean rate in this group elevated from 8.0% to 10.2%. Reasons for cesarean changed as well—those performed due to fetal issues without the use of oxytocin rose from 1.3% to 2.6%, and cases linked to poor uterine response during labor increased from 0.9% to 2.1%. Cesareans due to persistent malposition or a mismatch between the baby's head and the mother's pelvis also became more common, increasing from 0.8% to 1.5%. In contrast, cesareans due to overcontracting of the uterus dropped from 1.2% to 0.4%.
Other labor outcomes shifted alongside these trends. The rate of postpartum hemorrhage (≥1000 mL) rose sharply, from 0.6% to 4.1%. Vaginal operative deliveries, such as forceps or vacuum use, raised from 24.9% to 29.0%, while the use of oxytocin to support labor declined from 52.6% to 48.0%. To sum up, this 18-year dataset illustrates that the ICDCS can offer detailed and consistent information when combined with the TGCS.
By looking at absolute rates of cesarean indications alongside other labor events and maternal outcomes, the study uncovered clear clinical patterns. These findings suggest that using both systems together could assist in refining guidelines for labor management and lead to better care decisions in maternity settings.
American Journal of Obstetrics and Gynecology
An Intrapartum Cesarean Delivery Classification System– a prospective eighteen year longitudinal cohort study
Michael Robson et al.
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