Evaluation of urgent caesarian according to colour code at the Befelatanana University Hospital Centre of Obstetric Gynecology in Antananarivo Madagascar

Randriamahavonjy Romuald, Rakotozanany Besaina, Ibrahim Housni, Rakotonirina Martial, Rakotoson Koloina Tiphaine, Hery Rakotovao Andrianampanalirivo


Background: Color code was described for the first time in 2003 was described for the first time in 2003 by since and al. The objective of this study was to accomplish urgent caesarian sections according to color code over delays indications-births (DIN) in Motherhood Befelatanana, Antananarivo, Madagascar.

Methods: It was about a longitudinal prospective, analytical study of caesarian sections performed in emergency in CHUGOB going from June 1st till December 31st, 2017.

Results: Authors took a census 193 caesarian sections of emergency. Among these patients 28 (14.50%) had a caesarian section encode red, 42 (21.76%) an orange code and 123 (63.73%) a green code. The medium age of the patients was of 26.4 years and that of the gestation was of 37SA and 6 days. The delay indication-birth (DIN) medium was of 102.9 minutes for red code, 99.7 minutes for orange code and 75 minutes for green code.

Conclusions: Authors could not attain DIN of 30 minutes shape in international recommendations. Authors must improve the delay indication entered in the surgical unit by reinforcing knowledge of the agents of support on the management of emergency obstetrical. The possibility of leading to a very quick birth is an indisputable progress in obstetrics but she should not make forget risks inherent in such procedure.


Caesarian section, Delay indication birth, Emergency, Forecast

Full Text:



Broch DE, Courtois L, Maillet R, Riethmuller D. Caesarean sections. EMC (Elsevier Masson SAS, Paris). Obstetrics. 2008;5:102-A-10.

Lucas DN, Yentis SM, Kinsella SM, Holdcroft A, May AE, Wee M, et al. Urgency of cesarean section: a new classification. JR Soc Med. 2000;93:346-50.

Deltombe-Bodart S, Grabarz A, Ramdane N, Delporte V, Depret S, Deruelle P, et al. Compliance to the color codes protocol according to the indication of cesarean and to the decision-to-delivery interval. Gynecol Obs Fertil Senol. 2018;46(7-8):575-9.

Linck C, Choserot M, Cristinelli S, Callec R, Morel O. Emergency caesarean sections in primary care maternity: Impact of a color code. J Gynecol Obs Biol Reprod. 2016;45(7):701-7.

Bloc F, Dupuis O, Massardier J, Gaucherand P, Doret M. Are we overusing of crash c-section procedure?. J Gynecol Obs Biol Reproduction. 2010;39(2):133-8.

Foumane P, Mve Koh V, Ze Minkande J, Njofang Ngantcha EA, Dohbit JS, et al. Risk factors and prognosis for emergency cesarean section at the Gynecology Obstetrics and Pediatric Hospital, Yaounde, Cameroon. Med Sante Trop. 2014;24:89-93.

Weiner E, Bar J, Fainstein N, Ben-Haroush A, Sadan O, Golan A, et al. The effect of a program to shorten the decision-to-delivery interval for emergent cesarean section on maternal and nonatal outcome. Am J Obstet Gynecol. 2014;210(3):El-224.e6.

Figueireido S, Tsatsaris V, Mignon A. Anaesthetic management for acute foetal distress. Ann Fr Anesth Réanim. 2007;26(7):699-704.

Mbongo JA, Butoyi JM, Papandi-Ikourou A, Iloki LH. Caesarean section in emergency at the Brazzaville University and Hospital Center. Afr J Med Health Sci. 2016;17(1):2-3.

High Authority of Health. Ceasarean planned for the future service evaluation and improvement of practices: HAS; 2014.

Chown KM, Mak SL. Maternal and fetal outcomes in extremely urgent caesarean delivery in relation to the decision-todelivery interval. Hong Kong J Gynaecol Obstet Midwifery. 2015;15(1):16-22.

Bello FA, Tsele TA, Oluwasola TO. Decision-to-delivery intervals and perinatal outcomes following emergency cesarean delivery in a Nigerian tertiary hospital. Int J Gynaecol Obstet. 2015;130:279-83.

Maneschi F, Biccirè D, Santangelo G, Perrone S, Scaini A, Cosentino C. Implementation of the four-category classification of cesarean section urgency in clinical practice. a prospective study. Gynecol Obs Investigation. 2017;82(4):371-5.

Huissoud C, Mesnildot P, Sayegh I, Dupuis O, Clément HJ, Thévenet S, et al. Color-codes implemention shortens the decision-to-delivery interval of emergency C-sections. J JGYN. 2009;38:51-9.

Dupuis O, Sayegh I, Decullier E, Dupont C, Clément HJ, Berland M, et al. Red, orange and green Caesarean sections: a new communication tool for on-call obstetricians. J EJOGRB. 2008;140:206-11.

Hirani BA, Mchome BL, Mazuguni NS, Mahande MJ. The decision delivery interval in emergency caesarean section and its associated maternal and fetal outcomes at a referral hospital in northern Tanzania: a cross-sectional study. BMC Pregnancy and Childbirth. 2017;17:411.

Huissoud C, Dupont C, Canoui-Poitrine, Touzet S, Dubernard G, Rudigoz RC. Decision-to-delivery interval for emergency caesareans in the Aurore perinatal network. J EJOGRB. 2010;149:159-64.

Kolas T, Hofoss D, OIAN P. Predictions for the decision-to-delivery interval for emergency cesarean sections in Norway. Acta Obs Gynecol. 2006;85:561-6.

Lurie S, Sulema V, Kohen-Sacher B, Sadan O, Glezerman M. The decision to delivery interval in emergency and non-urgent cesarean sections. J EJOGRB. 2004;113:182-5.

Sayegh I, Dupuis O, Clement HJ, Rudigoz RC. Evaluating the decision-to-delivery interval in emergency caesarean sections. J EJOGRB. 2004;116:28-33.

Lecerf M, Vardon D, Morello R, Lamendour N, Dreyfus M. Can we do a cesarean section in less than 30min in unsuitable premises in order to follow the recommendations of the ACOG?. J Gynecol Obs Biol Reproduction. 2013;42(4):393-400.

Onah HE, Ibeziako N, Umezulike AC, Effetie ER, Ogbuokir CM. Decision-delivery interval and perinatal outcome in emergency caesarean sections. J Obstet Gynaecol. 2005;25(4):342-6.

Livermore LJ, Cochrane RM. Decision to delivery interval: a retrospective study of 1000 emergency cesarean sections in Norway. Acta Obstet Gynecol Scand. 2006;85(5):561-6.

Yaich P, Ouattara A, Koffi N, Sanou J, Itéké F. Caesareans in emergency: maternal-fetal prognosis at Cocody hospital in Abidjan. RAMUR. Mai. 2012;17(1):2-5.

Cerbinskaite A, Malone S, McDermott J, Loughney AD. Emergency caesarean section: Influences on the Decision-to-Delivery Interval. Hindawi Pub Corp J Pregnancy. 2011:6.

Thomas J, Paranjothy S, James D. National cross sectional survevy to determine whether the decision ton delivery interval is critical in emergency caesarean section. BMJ. 2004;328(744):665.

Mofolo N, Cronjé P, Gobodo M, Magano O, Mothiba M, Pierce N, et al. Adherence to the 30-minute rule in emergency caesarean deliveries due to foetal distress at Pelonomi Tertiary Hospital, Bloemfontein, South Africa. PULA: Botswana Afr J Studies. 2017;31(2):2-6.

McCahon RA, Catling S. Time required for surgical readiness in emergency caesarean section spinal compared with general anesthesia. Int J Obstet Anesth. 2003;12:178-82.

Lagrew DC, Bush MC, McKeown AM, Lagrew NG. Emergent (crash) cesarean delivery: indications and outcomes. Am J Obstet Gynecol. 2006;194:1638-43.

Helmy WH, Jolaoso AS, Ifaturoti OO, Afify SA, Jones MH. The decision-to delivery interval for emergency caesarean section: is 30 minutes a realistic target? BJOG. Int J Obstet Gynaecol. 2002;109:505-8.

Pierre F, Rudigoz RC. Emergency caesarean delivery: Is there an ideal decision-to-delivery interval? J Gynecol Obstet Biol Reprod. 2008;37:41-7.

Lafitte AS, Vardon D, Morello R, Lecerf M, Stewart Z, Dreyfus M. Can we reduce the decisio-to-delivery interval in case of emergency cesarean sections by optimizing the premises ‘architecture? EMC Gynecol Obstétrics Fertility Sénol. 2017;45:590-5.

Tolcher MC, Johnson RL, El-Nashar SA, West CP. Decision-to-Incision Time and neonatal Outcomes. Obstet Gynecol. 2014;123:536-48.

Pearson GA, Kelly B, Russell R, Dutton S, Kurinczuk JJ, et al. Target decision to delivery intervals for emergency caesarean section based on neonatal outcomes and three year follow-up. Eur J Obstet Reprod Biol. 2011;159:276-81.

Mishra N, Gupta R, Singh N. Decision Delivery Interval in Emergency and Urgent Caesarean Sections: Need to Reconsider the Recommendations?. J Obs Gynecol India. 2018;68(1):20-6..

Bello FA, Tsele TA, Oluwasola TO. Decision-to-delivery intervals and perinatal outcomes following emergency cesarean delivery in a Niger tertiary hospital. Int J Gynaecol Obstet. 2015;130:279-83.