Data collected
The data were collected from medical digital files via DxCare® software, using the keywords ”cesarean section during labor - laparotomy” and ”emergency cesarean section except labor- laparotomy” and, if necessary, from paper files including the partogram.
The clinical data collected were : maternal age, pre-pregnancy body mass index (BMI) [weight in kg/size² in metres], gravidity, parity, uni- or multi-scarred uterus. Obstetric data collected were: gestational complications and their type, type of pregnancy (single or multiple), occurrence of fetal death in utero or therapeutic termination of pregnancy, gestational age at which cesarean section was performed, occurrence during labor, and labor induction. Peroperative data comprised: incision time, the surgical technique used, possible presence of surgical difficulties, the occurrence of postpartum hemorrhage (defined by the presence of blood loss >500 mL), total peroperative blood loss, and operating time. The following data on anesthesia were also collected: epidural anesthesia administered prior to cesarean section, type of anesthesia performed during the cesarean section, any changes in anesthesia during cesarean section and their reasons.
Neonatal data collected included: birth weight, sex of child, arterial pH and arterial lactates collected from the cord after birth, Apgar score at 1, 5 and 10 minutes, the need for neonatal resuscitation, the need for hospitalization in the neonatal unit including the reason and duration, and the occurrence of a neonatal death. Post-operative maternal data collected were: length of stay, maternal postpartum anemia (defined by hemoglobinemia below 11 g/dL), the need for transfusion, maternal complications and their type (venous thromboembolic event, surgical site infection, hemorrhagic complication, digestive or bladder), and the need for surgery.
To assess protocol compliance the color code indicated by the on-call obstetrician was noted for each patient, as well as the indication for the cesarean section mentioned in the cesarean section report. Based on this information, we checked that the color code was in line with the indication according to the protocol. We also noted any lack of mention of a color code in the file. In the event of non-compliance with the protocol or the absence of mention of a color code, we allocated a code according to the indication noted on the operational report. The decision-delivery interval was calculated by calculating the time between the decision to perform a cesarean section and the time of delivery. Compliance with the decision-delivery interval was verified according to the color code used by the on-call team.