Results
Of 300 women underwent emergency cesarean section; 150 had their cesarean section before (during 2015-2016) and another 150 after (during 2017-2018) implementation of the “code blue” protocol.
Table 1 shows comparison of baseline characteristics between the 2 groups. Both groups were comparable with regard to maternal age, GA at delivery, and parity. The most common indication for emergency cesarean section in both groups were abnormal FHR in NICHD category III (95.3% vs. 82% in before and after “code blue” group, respectively) and majority of decisions were made during office hours (65.3% vs. 64.7% in before and after “code blue” group, respectively). However, general anesthesia was significantly more common in women after than before “code blue” group (94% vs. 28%, respectively, p<0.001).
Table 2 shows the comparison of various time intervals after decision of cesarean section between the 2 groups. The median time interval for every process was significantly lower in the group after “code blue” compared to those before “code blue” (DRI: 8 vs. 25 minutes, p<0.001; DII: 18 vs. 45 minutes, p<0.001), DDI: 22 vs. 52 minutes, p<0.001). In addition, the group after “code blue” was significantly more likely to have DDI of < 30 minutes than those before “code blue” group (80% vs. 8%, respectively, p<0.001). Only 3.3% of after “code blue” group had DDI of >75 minutes compared to 28.7% in before “code blue” group.
Table 3 shows the comparison of various time intervals after decision of cesarean section between the 2 groups according to time of decision. Every time interval was significantly shorter among those in after than before “code blue” group (p<0.001) both when decision was made during office and after office hours. Within both before and after “code blue” groups, each time interval, as well as proportion of women with DDI of ≤30 minutes were not significantly different between decision made during office and after office hours.
Table 4 shows comparison of pregnancy outcomes between the 2 groups. Both groups had comparable neonatal outcomes in terms of birth weight, Apgar scores, and NICU admission.