Traffic-light system for cesareans shows benefits
Issue 15: 11 Aug 2008
Source: European Journal of Obstetrics & Gynecology and Reproductive Biology 2008;in press
A trial of a novel "traffic-light" color-coding system for specifying the urgency of cesarean sections has been shown to significantly shorten the time from decision to delivery.
Specialists at centers in Pierre-Benite and Lyon, France, developed and tested the communication tool, which is intended for on-call obstetricians to use in order to convey the degree of urgency for cesarean section to the rest of the perinatal team.
In the three-color system, it was suggested that red should be used to indicate very urgent cases corresponding to life-threatening situations (to the mother or fetus) and warranting an ideal decision-to-delivery time (the time interval from the decision being made to perform a cesarean section, to the birth of the infant) of 15 minutes.
This covers seven situations: hemorrhage from placenta previa, placental abruption, umbilical cord prolapse, suspected uterine rupture, failure of operative vaginal delivery performed for abnormal fetal heart rhythm, acute fetal bradycardia without recovery, and maternal seizure related to eclampsia.
The orange code would refer to urgent cases, warranting an ideal decision-to-delivery interval of 30 minutes. It was suggested that this would include cases of operative vaginal delivery failure, and cases of persistent abnormal fetal heart rhythm.
The green code would be used for non-urgent cases, with an ideal decision-to-delivery interval of 60 minutes. This would include cesarean section performed due to failure to progress or due to abnormal presentation.
The developers intend that the on-call obstetrician would inform the perinatal team of the code (red, orange, or green) as soon as a cesarean is deemed necessary.
In a new paper due to be published in the European Journal of Obstetrics & Gynecology and Reproductive Biology, the researchers (Dupuis et al) report the findings of their trial of the system. They compared decision-to-delivery intervals in two 6-month periods: before and after introduction of the system. Relevant hospital staff were informed fully about the new scheme before it was introduced.
The study was confined to all emergency cesarean sections in the study periods: 96 cases in the first period (15 deemed very urgent, or red; and 81 deemed urgent, or orange) and 78 cases in the second period (14 deemed very urgent, or red; and 64 deemed urgent, or orange).
The overall mean decision-to-delivery interval before introduction of the code was found to be 39.6 minutes. After introduction of the code this had been reduced significantly, to a mean of 31.7 minutes.
The mean decision-to-delivery interval for the very urgent (red) cases was reduced from 21.3 minutes to 19.1 minutes, while the mean decision-to-delivery interval for the urgent (orange) cases was reduced from 42.5 minutes to 34.4 minutes
Reductions were seen in the time from decision to operating theater, and in the time from incision to delivery. The period of preparation in-between, from the arrival of the patient in theater to the first incision, was the same before and after introduction of the code.
The researchers conclude that the study indicates that "use of the three-color code could significantly shorten the decision-to-delivery interval in emergency cesarean sections" by clearly communicating the degree of urgency within the perinatal team. Prospective studies are needed to investigate use of the system further, they add.