Secondary cesarean section during delivery

SNOMED Groups Translation User Group
1

Question from Austria and the Netherlands:

The meaning of secondary cesarean section in Austria and NL is: unplanned cesarean section during delivery - no emergency. In English this means the second cesarean section.

What does secondary cesarean section means in other countries? Is there a term that means unplanned cesarean section during delivery (without being it a emergency) used by the gynaecology and what is it named?

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In Sweden, we have 3 kinds of cesarean deliveries: planned, unplanned but not urgent, and urgent as in life-saving. For the second we would use “akut kejsarsnitt”, and akut here being the same word as in emergency department. “Akut” is the opposite of Planned., but there are two kinds of unplanned. We would not call it secondary cesaren.

Well.. now I add a 4th
 planned but the onset came earlier than expected


3

Our medical specialist says that there is no Norwegian term that corresponds exactly to “secondary cesarean section”. During his previous clinical work at St. Olavs hospital i Norway, there were three kinds of cesarean sections:

1 “Elektiv sectio” (=Elective cesarean section”): Planned cesarean section.

2 “Hastesectio” (=”Urgent caserean section”): Not planned, but something happens that makes it necessary to deliver the baby, for example within 20-30 minutes. This corresponds to urgency level 2, possibly 3, se current guidelines below.

3 “Katastrofesectio” (=”Catastrophic cesarean section”): Not planned, but something happens that means the baby must be delivered as quickly as possible, within a few minutes. This corresponds to urgency level 1 below

In current guidelines (Metodebok), we find the following classification:

Emergency cesarean section is graded according to urgency:

  • Urgency level 1: determined and performed as soon as possible.

  • Urgency level 2: determined and performed quickly within an agreed time frame, often 20 or 30 minutes, cf. local procedures.

  • Urgency level 3: determined and performed within a certain time frame, often 1 to several hours."

I hope this is helpful, @edegroot .

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It seems that Denmark has the same levels as in Norway.

5

Hi there,

thank you for your commments. I spoke to our subject matter experts again and it seems that we have a different meaning for ‘secondary section’ in Austria compared to the Netherlands:

Type of Section Meaning Comment Source (DE)
Primary Section (“PrimĂ€re Sectio”) caesarean section before the onset of labour (i.e. before the onset of contractions or rupture of the membranes) This includes both elective caesarean sections and medically indicated primary caesarean sections (e.g. placenta praevia).
No correspondence in SCT Pschyrembel Online
Secondary Section (“SekundĂ€re Sectio”) caesarean section after the onset of labour (i.e. before the onset of contractions or rupture of the membranes) No correspondence in SCT Pschyrembel Online
Emergency Section (“Akutsectio”/“Notsectio”) Corresponds to 274130007 Emergency cesarean section (procedure)

So it seems that this is not really a question of translation or localisation. Nevertheless, I would be interested to know whether other countries also use this classification (perhaps Germany @fgeier or Switzerland? @sneuenschwander ) or whether this is an Austrian-specific issue that we should include in the Austrian extension only.

6

Hi Annatina, I think it might be useful if I add to this in text in addition to the meeting.

In the Netherlands, from what I can find at least, a primary cesarean section means one that was decided upon before the onset of labor. It is now often also called a planned cesarean section. A secondary cesarean section means one that was decided upon during labor, which is now also often called an unplanned cesarean section. The terms ‘planned’ and ‘unplanned’ are more everyday in use, but nonetheless medical literature also uses them. There is also an emergency cesarean section, which is always unplanned but an unplanned cesarean does not have to coincide with a medical emergency. The delineation of emergency is mostly based on the DDI in minutes, whereby a category 1 needs a DDI under 30 minutes, and a category 2 a DDI under 75 minutes (Timing bij ongeplande sectio’s - Richtlijn - Richtlijnendatabase).

So, we definitely would benefit from concepts that distinguish between a planned and an uplanned one, in addition to the emergency cesarean that is already in SCT.

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Same for Swedish, Mirte!

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The three types of caesarean in Swedish:

Caesarean before onset, elective or urgent (ELEKAKUT)

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Hi @mvandenberg , that means that the Dutch and the German/Austrian/Swiss definitions of primary and secondary cesarean sections are very close, although the definition is based on an other aspect (the “plannedness”).
A colleague pointed out that the definition of “primary cs” and “secondary cs” seem to be specific for the German speaking countries, see https://register.awmf.org/assets/guidelines/015-084l_S3_Sectio-caesarea_2020-06_1_02.pdf : “Die gewĂ€hlten Unterscheidungen sind fĂŒr den deutschsprachigen Raum charakteristisch. Im internationalen Kontext ist eine derartige Unterscheidung nicht zu finden” (The distinctions [i.e. primary/secondary] chosen are characteristic of German-speaking countries. In an international context, such a distinction cannot be found).
I plan to put a CR forward to include these concepts, since at least three countries would use them (Switzerland, Germany and Austria; not sure about the Dutch case).
Best regards and soon: Happy new year!,
Annatina

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@annatina

In making your CRS request for these terms, it would be essential to provide accepted International definitions for the terms to ensure that they are interpreted properly by other Members who are not familiar with this usage outside of the German-speaking countries.