National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Classification for Urgency of Caesarean Section: A Prospective Observational Study

Background: The conventional binary classification of caesarean section categorizes planned operations as ‘elective’ and all other caesarean indications as ‘emergencies’. These definitions are imprecise as all non-elective cases are labelled as emergencies, although some are distinctly more urgent than others. National Confidential Enquiry into Patient Outcome and Death (NCEPOD) classification is used to classify surgical procedures based on the urgency as emergency/urgent/scheduled and elective. It is a simple, valid, reliable classification which can be used across health care units. The recent 2024 NICE guidelines endorse the nomenclature of indications as: Emergency, Urgent, Scheduled and Elective as per the Decision to Delivery interval [DDI]. This classification will help in addressing the challenges encountered during the DDI, assessing the urgency of the indication and retrospective audit of outcomes.

Aims & Objectives: This study aims to classify caesarean sections according to the urgency using the NCEPOD classification.

Methodology: A prospective observational study was done on all women undergoing Caesarean sections in a tertiary care teaching hospital. The details pertaining to indication, classification of the indications according to the older binary classification and the study classification was done as per the DDI. The indications were tabulated and compared. The reasons for delay if any were studied.

Results: As per the binary classification, our study showed 19.8% elective cases & 80.19% emergency cases. After following the NCEPOD classification, the indications were reclassified into Emergency cases- 34.9%, Urgent cases- 21%, Scheduled cases-13.7% & Elective cases- 30.27%. There was a striking difference in the classification of indications under the ‘Emergency’ category.

Conclusion: Classification of caesarean deliveries as per the DDI will help in better triage of the patients. Using the binary classification large chunk of patients are classified as emergency. DDI provides insights into indications for the real urgency and emergency nature of the indication. It is strongly recommended to classify the indications of caesarean section as; Emergency, Urgent, Scheduled and Elective as per the DDI.