Abstract:
Spinal anesthesia is a type of regional anesthesia that has been practicing for obstetric
anesthesia since the beginning of the 20th century. Despite the simplicity and lower maternal mortality risk,
compared to general anesthesia, spinal anesthesia is linked to different adverse effects, of which hypotension
is the most common complication. There is scarcity of comprehensive data on hypotension during spinal
anesthesia and its associated factors in this study area.
Objective: This study aimed to determine the prevalence and factors associated with spinal anesthesia
induced hypotension during cesarean section at Hiwot Fana Specialized University Hospital and Jugal
General Hospital, Harar, Ethiopia November 20, 2024- January 20, 2025.
Method: An institution-based cross-sectional study was used among 389 mothers who underwent cesarean
section. A simple random sampling technique was applied to select the study participants. Data were
collected using a pre-tested structured questionnaire supplemented with a review of medical records. Data
were entered using Epi-Data 3.1 and analyzed using SPSS 26. Both bivariable and multivariable logistic
regression analysis was employed to identify factors associated with outcome variable. All variables, with
P-value less than 0.3 in bivariable analysis were included for multivariable logistic regression analysis.The
level of statistical significance was declared at p<0.05. Strength of association was described with AOR
along with 95% confidence interval A total of 388 (with 99.7% response rate) data were analyzed. The mean age of the mothers were
27.58 (±4.21SD) years. The prevalence of hypotension among mothers who underwent a cesarean section
after spinal anesthesia was 59.28% (95% CI; 54.4-64.20). Newborn weight of ≥2.5 kg (AOR = 6.89; 95%
CI: (2.986-15.907), estimated blood loss 500-1000ml (AOR, 2.87(95% CI: 1.525-5.396), being positioned
supine before spinal anesthesia (AOR = 2.02; 95%CI: (1.243-3.268)) and greater than 1 hr duration of
surgery (AOR = 1.97(95%CI: 1.248-3.105) had shown positive association with hypotension.
Conclusion: The prevalence of hypotension was high. Newborn weight, patient position before spinal
anesthesia, the duration of surgery, and estimated blood loss are factors associated with hypotension after
spinal anesthesia. Decreasing duration of the surgery, controlling bleeding, and optimizing preoperative positioning of the patient are critical aspect to prevent hypotension. By addressing these factors, the
prevalence of hypotension after spinal anesthesia can be significantly decreased. In addition, it’s our
recommendation for longitudinal studies to recognize the long-term effect of spinal induced hypotension.
