(128) “CODE OB”: The Impact of Hospital-Wide Announcements on Decision-to-Incision Interval, Neonatal Outcomes in Emergency C-Sections

Objective:
This study evaluates the effect of calling a hospital-wide obstetrical code on decision-to-incision (D-I) interval and neonatal outcomes for different emergency C-section indications. D-I intervals, arterial cord pH, arterial base deficit, and five-minute APGARs were assessed in relation to whether or not a code was called for bleeding placenta previa, placental abruption, category 2 tracing, category 3 tracing, cord prolapse, uterine rupture, and other indications (active herpes, detectable HIV, or malpresentation in active labor; uncontrolled pre-eclampsia/HELLP, etc.)

Study Design:
A retrospective cohort study analyzing all emergency C-sections (689) between August 2017 and April 2023 was performed. Two-sample t-tests assessed for potential statistical significance in D-I interval and neonatal outcomes between code and non-code emergency deliveries for each hysterotomy indication.

Results:
D-I time appeared to improve when a code was called for every indication except for bleeding placenta previa (insufficient sample size) and cord prolapse (9.91 minutes vs. non-code: 24.25 minutes, p = 0.07). For placental abruptions, there was a statistically significant difference in cord pH (7.12 vs. 7.24, p = 0.007) and base excess (-9.44 vs. -5.83, p = 0.05) between code and non-code c-sections. Calling a code appeared to have no effect on five-minute APGARs for any indication. When all indications were combined, there was a statistically significant difference in D-I interval (11.50 vs. 49.06 minutes, p = 1.86E-69), cord pH (7.13 vs. 7.22, p = 5.37E-9) and base excess (-8.79 vs. -5.79, p = 1.62E-7) between code and non-code c-sections.

Conclusion:
It appears that calling a code in emergency c-sections shortens D-I interval but does not improve neonatal outcomes.