The use of colour codes for emergency caesareans has significantly improved team communication and protocol compliance over time. However, the impact on neonatal prognosis remains to be demonstrated.

Our main objective was to evaluate changes in neonatal morbidity and mortality over time for orange-code (decision-delivery interval ≤ 30 mins) and red-code caesareans (decision-delivery interval ≤ 15 mins), since the introduction of the colour-code protocol. The secondary objectives were to describe maternal complications and types of anaesthesia.

This retrospective single-centre observational study was carried out in the maternity ward of the Rennes University Hospital and included all patients for whom an emergency caesarean was performed with an orange or red code between 1st January 2015 and 31st December 2021. A composite endpoint of neonatal morbidity and mortality was defined as the primary outcome. A sample of 1301 patients and 1346 newborns was analysed.

Compliance with the colour-code protocol increased significantly during the study period to reach in 2021 97.8 % usage of appropriate colour codes according to the indication ( p < 0.0001) and 92.1 % concordance between the colour code and the decision-delivery interval ( p < 0.0001). In contrast, changes in neonatal outcomes were minimal and not statistically significant ( p = 0.5873). However, the risk of maternal complications did not increase and there was no difference in the rate of general anaesthesia ( p = 0.2002).

The colour-code protocol did not show significant changes in neonatal outcomes but remains a relevant reference tool to coordinate the labour ward teams.