# Impact of Obstetrical Emergency Code (Code Pink) Activation on Maternal and Neonatal Outcomes: A Retrospective Study

## TL;DR

This study examines how a hospital's emergency response system (Code Pink) affects outcomes for mothers and newborns during obstetrical emergencies.

## Contribution

The study provides empirical evidence on the effectiveness of Code Pink in a Middle Eastern tertiary hospital setting.

## Key findings

- Cesarean sections accounted for 90.1% of deliveries during Code Pink activations.
- Longer response times were significantly associated with higher NICU admissions (p < 0.001).
- Fetal distress was the leading cause for Code Pink activation at 72.7% of cases.

## Abstract

Background

Obstetrical emergencies require rapid, coordinated responses to mitigate adverse maternal and neonatal outcomes. Hospitals use standardized emergency codes to ensure quick staff mobilization. Limited data exist on implementing obstetric emergency codes in the Middle East. This study evaluates the effectiveness of obstetrical emergency code activation (Code Pink) in a tertiary care hospital, focusing on its impact on maternal and neonatal outcomes.

Methodology

This retrospective cohort study was conducted in Latifa Women and Children Hospital, Dubai, UAE, a tertiary care center, between January 2020 and December 2022. The hospital records of 394 deliveries that required Code Pink activation were reviewed for maternal and neonatal outcomes. This retrospective, hospital-based study was conducted on a total of 381 participants. There were 12 cases of multiple pregnancies (one triplet and 11 twins); 394 deliveries were conducted. Key variables assessed included demographic data, obstetric history, indication for code pink, decision-to-delivery interval (DDI), mode of delivery, anesthesia used, blood loss, maternal complications, neonatal APGAR scores, umbilical cord pH, and NICU admission. Descriptive and inferential statistical analyses were performed using SPSS Statistics version 25.0 (IBM Corp., Armonk, NY, USA), and chi-square tests and t-tests were used to determine associations. A p-value < 0.05 was used as a threshold for significance.

Results

The mean age and BMI of the participants were 31.99 ± 6.12 years and 30.44 ± 5.45, respectively. Cesarean sections accounted for 90.1% (n=343) of deliveries, with general anesthesia used in 64.3% (n=245) of cases. The median APGAR scores were 7 at one minute and 9 at five minutes. Fetal distress was the leading indication for emergencies at 72.7% (n=245), followed by maternal causes at 15% (n=57). The NICU admission was observed in 46.4% (n=183) of neonates, with a statistically significant association between longer response times and higher NICU admissions (p < 0.001). Cesarean delivery was also significantly associated with increased NICU admissions (p = 0.024).

Conclusions

This study underscores the importance of code pink activation in urgent, life-saving obstetrical measures that improve mother and newborn outcomes. High-quality treatment requires improving training, simplifying methods, and using data-driven tactics. This study offers a foundation for future emergency obstetric care research and improvement.