Research Implications
To improve protocol compliance, it would be interesting to study the
elements that lead to non-compliance and thus improve our
decision-delivery interval. In some studies, these elements appear to be
the time between the decision to perform a cesarean section and entry
into the operating room, organizational deficiencies, or anesthesia
difficulties (8,16). Protocol compliance could also be improved by team
simulation training which has been shown to be effective in improving
the management of many pathologies in obstetrics, especially
when requiring coordinated teamwork (17–20).
Strengths and limitations
The main strength of our study is the large patient sample which ensures
robustness of the results on the main judgment criterion. Our population
of 800 patients undergoing non-elective cesarean section is one of the
largest series studying color codes in this setting. On the other
hand, a higher power would have been required to demonstrate the
decrease in the rate of per-partum asphyxia following the implementation
of the protocol. The main weakness of our study lies in its
retrospective design implying the usual biases inherent to this type
of study mainly due to missing data. It is more than possible that some
data, such as the color code, were announced orally at the time of the
cesarean section decision but not recorded in the medical records. A
prospective study would help to overcome this bias and to assess current
practices as accurately as possible.