Clinical implications
We observed a significant increase in compliance with the protocol for
red code cesarean sections to reach full compliance in 2018 (p =
0.0020). However, despite better compliance with the decision-delivery
interval imposed by the protocol, there was no significant difference in
neonatal morbidity. This is in accordance with a literature review by
Pierre and al. who report that the pathology leading to emergency
cesarean section outweighs the neonatal prognosis over the mere
adherence to a short decision-delivery interval (15).
While there was no significant difference in neonatal mortality outcomes
in our population overall in terms of compliance with the protocol,
there appeared to be a trend towards a decrease in the number of
newborns with an arterial pH of less than 7 at birth, an Apgar score of
less than 7 at 5 minutes of birth, and neonatal deaths between 2015 and
2018. It can then be assumed that adherence to the protocol leads to a
decrease in the number of cases of neonatal asphyxia. This lack of
significance of the results can be explained by inadequate power of our
study to demonstrate this point. It would therefore be interesting to
conduct a study with higher numbers to confirm this hypothesis.
Our study revealed that some indications of non-elective cesarean
sections did not appear in the protocol. These non-protocol indications
included preeclampsia, HELLP syndrome, intrauterine infection, and
maternal shock, pathologies which don not necessarily require a cesarean
section depending on the severity of the pathology. This underlines one
of the limitations of the protocol in that a specific color code is not
always adequate. It is important thus to remember that while such a
protocol assists decision making in current practice, it is crucial to
adapt management to each clinical situation for optimal outcome.