Effect of a Colour Code Tool to Prioritize Emergency Caeserian Section on Decision to Delivery Time Interval and Pregnancy Outcomes at Kenyatta National Hospital: a Quasi-experimental Study

Abstract

Background Caesarean section (CS) rates of 10% to 15% are recommended by the World Health Organization to reduce maternal and perinatal complications. Even though there is well-documented evidence of increased maternal mortality associated with caesarean deliveries, the rate of caesarean deliveries has been increasing worldwide. It is recommended that caesarean sections under category I be delivered within 30 minutes, but the goal has remained elusive. It appears that prolonged DDI is associated with poor neonatal outcomes with numerous studies linking it to the condition. The aim of this study is to introduce a colour coding tool to classify emergency caesarean section at Kenyatta National Hospital maternity unit and assess its impact on pregnancy outcome and DDI. Objective To evaluate the effect of a colour code tool to prioritize emergency Caesarean Section on DDI and pregnancy outcome at the Kenyatta National Hospital. Methodology A quasi experimental, before after study design of parturient requiring emergency Caesarean section at Kenyatta National Hospital (KNH) maternity unit conducted between August 2020 and October 2020. It was done in two phases: Phase I, the period before the introduction of colour code, and phase II, the period after the introduction of colour code. Sampling was conducted using consecutive sampling. Participants were followed up through theatre and post operatively and the DDI, maternal and neonatal outcome were captured using a structured questionnaire. Data collected was analysed using STATA version 15. Results Two hundred and eighty-six patients were included (one hundred and forty-four in phase I and one hundred and forty-two in phase II. Patient’s demographic and obstetric characteristics were comparable between the two groups. With a p value of 0.012, the median decision to delivery time interval for phases I and II, respectively, was 256 minutes and 169 minutes. A shorter decision to delivery time interval was linked to color coding (adjusted odds ratio 1.63 (1.02 to 3.14)). Both groups' newborn and maternal outcomes were comparable. Conclusion Our results indicate that the three-color code tool's deployment greatly reduced the time between the decision and delivery but had no effect on the neonatal or maternal outcome. Recommendation Use of the three-color coding system to reduce the turnaround time for Caesarean sections. To identify obstacles to obtaining the goal DDI, more research must be conducted.