Hemodynamic changes after spinal anesthesia in preeclamptic patients undergoing cesarean section at a tertiary referral center in Ethiopia: a prospective cohort study

Tikuneh Yetneberk Alemayehu,Mamaru Molallign,Yophetah Woldegerima Berhe,Habtamu Getnet

doi:10.1186/s13037-020-00234-w

Tikuneh Yetneberk Alemayehu, Mamaru Molallign + Show 2 more

Open Access

https://doi.org/10.1186/s13037-020-00234-w

Copy DOI

Abstract

BackgroundSpinal anesthesia-induced maternal hypotension is the most frequent complication associated with maternal morbidity and mortality during Cesarean section. The aim of this study was to compare the incidence and magnitude of hemodynamic changes in preeclamptic and non-preeclamptic parturients undergone Cesarean section under spinal anesthesia.MethodA prospective cohort study was conducted from 01 February to 28 May 2019 in preeclamptic and non-preeclamptic parturients. We hypothesized preeclamptic parturients are at high risk of spinal anesthesia induced hypotension than non preeclamptics. A total of 122 ASA II and ASA III parturients were recruited consecutively and assigned to two groups (81non-preeclamptics, and 41 preeclamptics). Parturients with cardiac disease, twin pregnancy, chronic hypertension, gestational hypertension, superimposed hypertension, renal disease, diabetes mellitus, coagulopathy (platelet count < 80 × 109/L), active labor, eclampsia, abruptio placentae, placenta praevia, any adjuvant added with local anesthetics were excluded. The data analysis was done using SPSS version 22 statistical software. Student t test, MannWhitney U test and Fisher exact test were used to compare the data. All P values < 0.05 were considered statistically significant.ResultThe incidence of spinal anesthesia-induced hypotension was higher in non-preeclamptic parturients than preeclamptic parturients (55.6% vs. 34.1%, respectively) and the degree of blood pressure drop was significantly greater in the non-preeclamptic parturients compared to those with preeclampsia; As well intraoperative fluid consumption was significantly greater in the non-preeclamptics parturients compared to those with preeclamptics.ConclusionThe incidence and magnitude of spinal anesthesia-induced hypotension in parturients undergone Cesarean section were less in preeclamptic parturients than in non-preeclamptic parturients.. Based on the data from this study we recommended spinal anesthesia for preeclamptic patients, unless there is a contra indication based on preeclampsia.

Highlights

Spinal anesthesia-induced maternal hypotension is the most frequent complication associated with maternal morbidity and mortality during Cesarean section
The incidence and magnitude of spinal anesthesia-induced hypotension in parturients undergone Cesarean section were less in preeclamptic parturients than in non-preeclamptic parturients
Based on the data from this study we recommended spinal anesthesia for preeclamptic patients, unless there is a contra indication based on preeclampsia

Summary

Introduction

Spinal anesthesia-induced maternal hypotension is the most frequent complication associated with maternal morbidity and mortality during Cesarean section. Worldwide preeclampsia/eclampsia is the third leading cause of maternal morbidity and mortality [1]. This is especially the commonest cause of fetomaternal complications in developing countries; around 40 to 60% of maternal deaths in these countries are caused by preeclampsia alone; in Ethiopia,19% of maternal mortality is caused by hypertensive disorder of pregnancy [2]. Hypotension after spinal anesthesia was the most frequent complication associated with maternal morbidity and mortality during Cesarean section [8]. Preeclamptic patients have been considered to be at higher risk of profound hypotension when they undergo Cesarean section under spinal anesthesia [9]

Objectives

Methods

Results

Discussion

Conclusion