PREVALENCE AND FACTORS ASSOCIATED WITH HYPOTENSION AFTER SPINAL ANESTHESIA DURING CESAREAN SECTION AT PUBLIC HOSPITALS IN HARAR TOWN, ETHIOPIA.

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.