Implementation of the four-category classification of cesarean section urgency in clinical practice. A prospective study

Purpose: This study is aimed at investigating the clinical efficacy of the 4-category classification of urgent cesarean section. Methods: Women giving birth from September 2012 to December 2014 were prospectively investigated. Urgency C-section categories were color-coded: red - maternal/fetal life threat; yellow - maternal/fetal compromise, not life-threatening; and green - early delivery necessary. Results were audited. Results: A total of 4,754 women gave birth in the period considered, 1,313 (27.6%) with C-section of which 867 were urgent. The code was red in 0.98% of women, and 91.5% of newborns were delivered <= 30'; yellow in 5.1%; and green in 11.7%. The mean decision-to-delivery interval (DDI) +/- SD was 19.6 +/- 9.5 min, 36.6 +/- 15.3 (p < 0.01), and 80.3 +/- 52.8 (p < 0.01), respectively; and mean umbilical pH was 7.24 +/- 0.10, 7.29 +/- 0.08 (p < 0.05), and 7.33 +/- 0.04 (p < 0.01) in the red, yellow, and green groups, respectively. Two (4.2%) red and 4 (2.2%) yellow newborns were acidotic. Mean DDI +/- SD decreased from 21.7 +/- 9.7 min in the period September 2012 to February 2013 to 17.4 +/- 9.7 min in the period February to December 2014 (p = NS). Conclusions: Four-category classification led to achieving the target time in >90% of category 1 emergency C-sections, and stratified newborns with significantly different acidosis levels.