[Improving the appropriateness of red code C-sections through a relevance review]

To evaluate the relevance of the "red code" caesarean section indication using the relevance grid developed by the Grenoble team.

We conducted a retrospective two-phase relevance review in a type 3 maternity hospital. "Red code" caesarean sections were identified via the shared medical record, and their indications were discussed by a pair of practitioners and then with the entire obstetric team. Validation rates were compared before and after team awareness (phase 1 [2022-2023] versus phase 2 [July-December 2024]) using a Fisher's exact test.

In phase 1, 109 caesarean sections were recorded, with 74% validated and 26% reclassified as "orange code". The main reasons for reclassification were excessive interpretation of fetal heart rate abnormalities and instrumental birth failure. In phase 2, of 22 caesarean sections identified, 21 (95.5%) were confirmed as "red code", indicating a significant improvement in the relevance rate (P=0.04).

The relevance review showed a significant improvement in the relevance of "red code" caesarean sections, thereby limiting over-reliance on this practice, a source of general anaesthesia and post-traumatic stress.