Implementation of the Four-Category Classification of Cesarean Section Urgency in Clinical Practice. A Prospective Study.
OBJECTIVE
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.
Gynecology and Obstetric Unit, AO San Giovanni Addolorata, Rome, Italy.
Francesco
F
Maneschi
Desiree
D
Biccirè
Giusi
G
Santangelo
Seila
S
Perrone
Alberto
A
Scaini
Carmine
C
Cosentino
D000328:Adult; D002585:Cesarean Section / Q000145:classification*; D036861:Delivery, Obstetric / Q000145:classification*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011446:Prospective Studies; D013997:Time Factors; D061665:Time-to-Treatment / Q000145:classification*
Acidosis; Cesarean section; Classification; Decision-to-delivery interval; Emergency