Implementation trial of color coding for emergency caesarean section management in resource-limited settings

Abstract

Context and objective. An emergency caesarean section carries a greater risk of complications for the mother and her baby than a normal delivery. Worldwide, the proportion of births by emergency caesarean section has risen sharply in recent decades. The aim of this study was to evaluate the impact of implementing color coding on decision-extraction time and maternal-fetal prognosis in the management of emergency caesarean sections in resource-limited settings. Methods. This was a cross-sectional analytical study that took place in the Matanda Hospital Maternity Unit in the Province of North-Kivu in the Democratic Republic of Congo. Data were collected prospectively over a 6-month period from 1 June to 30 November 2021. The study population consisted of parturient who had undergone an emergency caesarean section. Data processing was performed using Epi Info software version 7.2.4.0. Results. The frequency of emergency caesarean section in this study was 27.99%. The mean age of parturient was 29.07 years, with extremes of 16 and 43 years. Acute fetal distress was the most frequent indication (19.3%). For red code indications, the decision-extraction time was more than 15 minutes in 70.37% of cases. However, for Orange and Green codes, the extraction time was exceeded in 32% and 25% of cases respectively. The lengthening of the decision-to-birth delay was attributed to three types of delay: delay in installation (44.6%), delay in anesthesia (19.3%) and technical difficulties in extraction (12.6%). There was no statistically significant correlation between delay in decision to deliver and fetal outcome, but rather between the mode of admission and neonatal mortality, with an OR of 63.00 [15.33-258.86] (p<0.0001). Conclusion. The use of color coding in resource-limited settings does not appear to improve the maternal-foetal prognosis of emergency caesarean sections. Working conditions should be improved for its feasibility.

Received: June 8^th, 2023

Accepted: June 1^st, 2024

https://dx.doi.org/10.4314/aamed.v17i4.7