Abstract
Anesthetic management of preeclamptic patients remains a challenge. Although general anesthesia can be used safely in pre-eclamptic women, it is fraught with greater maternal morbidity and mortality. The added risks associated with general anesthesia include airway difficulties due to edema (often aggravated by tracheal intubation) and the pressure response to laryngoscope and intubation. However, several studies support the use of spinal anesthesia as first choice reasoning less post-operative morbidity and mortality. To compare maternal outcome among preeclamptic women after caesarian delivery under general and spinal anesthesia in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Hospital based retrospective comparative cross sectional study was used to compare maternal outcomes. All preeclamptic mothers that underwent Caesarian Section in Obstetrics and Gynecology Ward, Tikur Anbessa Specialized Hospital from October 2014 to October 2016 was included in the study. Data collection was carried out by using structured questionnaire. Data entry and analysis was done on SPSS version 20. Independent sample T-test and logistic regression was conducted to compare the outcome in both groups of spinal and general anesthesia, 95% confidence interval (CI) and p value < 0.05 is set as cut off point for statistical significance. The mean age of study subjects were 28.18 years and SD= ± 4.66 years, the median age is 28 years (IQR: 25-30 years). Majority 152 (91%) of the cesarean sections (C/S) was emergency C/S and the rest 15 (9%) were elective C/S. 78 (46.7%) of parturient operated under general anesthesia, and 89 (53.3%) were operated under spinal anesthesia. None of the mothers developed post-op complication, and none of the maternal death were documented until discharge from the hospital in both groups of parturient. The present finding shows that statistically significant higher intra operative blood pressure and pulse rate was observed among GA group when compared with SA group. In conclusion, SA is safer than GA in terms of stable intra operative vital signs among preeclamptic women. Key words: Preeclampsia, caesarean section, general anesthesia, spinal anesthesia, Ethiopia.
Highlights
Preeclampsia is a multi-systemic disorder characterized by hypertension and new-onset of proteinuria which develops after the 20th week of pregnancy in previously normo-tensive women
WHO estimates that the incidence of preeclampsia is 7 times higher in low- and middle-income countries than in high-income countries, and From 10 to 25% of these cases will result in maternal death (Engender Health, 2007; Dolea and AbouZahr, 2003)
The Ethiopian National Emergency Obstetric and Newborn Care (EMONC) survey showed that preeclampsia contributed to the complication of approximately 1% of all deliveries and 5% of all pregnancies
Summary
Preeclampsia is a multi-systemic disorder characterized by hypertension and new-onset of proteinuria which develops after the 20th week of pregnancy in previously normo-tensive women. It is a common cause of maternal and perinatal morbidity and mortality in both developed and developing countries affecting 2 to 8% of pregnancies (World Health Organization (WHO), 1988). According to Demographic Health Survey (1990 to 2014), the global cesarean section rate is 18.6%. The average cesarean section rate in Africa is 7.3%, the highest Egypt (51.8%) and 0.6% for Ethiopia which is very low. The national cesarean section rate in Ethiopia varies from 2 to 27% (Betrán et al, 2016)
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