Purpose: 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.

Osterman MJ, Martin JA: Changes in cesarean delivery rates by gestational age: United States, 1996-2011. NCHS Data Brief 2013;124:1-8.
Statement on emergency caesarean section rates. RCOG, 2013. http://www.rcog.org.uk/news/rcog-statement-emergency-caesarean-rates (accessed September 15, 2014).
Ministero Della Salute: Certificato di assistenza al parto (CeDAP) analisi dell'evento nascita - Anno 2010. http://www.salute.gov.it/imgs/c_17_pubblicazioni_2024_allegato.pdf (accessed September 10, 2014).
Lucas DN, Yentis SM, Kinsella SM, et al: Urgency of caesarean section: a new classification. J R Soc Med 2000;93:346-350.
Classification of Urgency of Caesarean Section - A Continuum of Risk (Good Practice Guideline No. 11). Royal College of Obstetricians and Gynaecologists/Royal College of Anaesthetists, 2010, pp 1-4.
Dupuis O, Sayegh I, Decullier E, et al: Red, orange and green caesarean sections: a new communication tool for on-call obstetricians. Eur J Obstet Gynecol Reprod Biol 2008;140:206-211.
Pearson GA, Kelly B, Russell R, et al. Target decision to delivery intervals for emergency caesarean section based on neonatal outcomes and three year follow-up. Eur J Obstet Gynecol Reprod Biol 2011;159:276-281.
American College of Obstetricians and Gynecologists: Standards of Obstetric-Gynecologic Services, ed 7. Washington, ACOG, 1989, p 39.
American Academy of Pediatrics/American College of Obstetricians and Gynecologists: Guidelines for Perinatal Care, ed 5. Washington, p 147.
Bloom SL, Leveno KJ, Spong CY, et al: Decision-to-incision times and maternal and infant outcomes. Obstet Gynecol 2006;108:6-11.
Thomas J, Paranjothy S, James D: National cross sectional survey to determine whether the decision to delivery interval is critical in emergency caesarean section. BMJ 2004;328:665-668.
Mckenzie IZ, Cooke I: What is a reasonable time from decision-to-delivery by caesarean section? Evidence from 415 deliveries. BJOG 2002;109:498-504.
Nageotte MP, Vander Wal B: Achievement of the 30-minute standard in obstetrics - can it be done? Am J Obstet Gynecol 2012;206:104-107.
Weiner E, Bar J, Fainstein N, et al: The effect of a program to shorten the decision-to-delivery interval for emergent cesarean section on maternal and neonatal outcome. Am J Obstet Gynecol 2014;210:224.e1-e6.
The Use and Interpretation of Cardiotocography in Intrapartum Fetal Surveillance. Clinical Guidelines. London, RCOG, 2001.
Clinical Effectiveness Support Unit: The National Sentinel Caesarean Section Audit Report. London, RCOG, 2001.
Graham EM, Ruis KA, Hartman AL, et al: A systematic review of the role of intrapartum hypoxia-ischemia in the causation of neonatal encephalopathy. Am J Obstet Gynecol 2008;199:587-595.
Holcroft CJ, Graham EM, Aina-Mumuney A, et al: Cord gas analysis, decision-to-delivery interval, and the 30-minute rule for emergency cesareans. J Perinatol 2005;25:229-235.
Leung TY, Chung PW, Rogers MS, et al: Urgent cesarean delivery for fetal bradycardia. Obstet Gynecol 2009;114:1023-1028.
Leung TY, Lao TT: Timing of caesarean section according to urgency. Best Pract Res Clin Obstet Gynaecol 2013;27:251-267.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.