Association of Pre-operative Factors to the Development of Spinal Anaesthesia Induced Hypotension During Caesarean Section at the Kenyatta National Hospital

Abstract

Background: Hypotension is one of the most common complications of caesarean section under spinal anaesthesia. It leads to increased maternal morbidity and mortality, as well as poor neonatal outcomes if untreated. Knowledge of pre-operative risk factors that can predict development of hypotension intraoperatively, would significantly help in identification of patients most at risk of intraoperative hypotension, enhance early preparation and timely intervention. Study Objective: To determine the association of pre- operative factors to the development of Spinal Anaesthesia Induced Hypotension (SAIH) and determine the incidence of spinal anaesthesia induced hypotension during cesarean section at the Kenyatta National Hospital. Methods Cross sectional observational study of paturients undergoing cesarean section under spinal anesthesia. Pre-operative maternal factors and baseline maternal vital signs were assessed. Logistic regression was used in multivariate analysis to determine and estimate the association between development of hypotension during cesarean section and socio-demographic, clinical and maternal factors. Results: From 354 eligible patients, incidence of SAIH was 29.6%. The odds of developing SAIH was increased by increasing maternal age by 2.4% and hemoglobin levels by 0.7% while the odds of developing SAIH was reduced by increasing BMI by 2.41%, fasting time by 3.3%, number of previous cesareans section by 2.98%, increasing systolic blood pressure by 4.90, MAP by 1.27% and HR by 0.62%. Conclusion: This study found the incidence of SAIH to be 29.6%. Of all the factors studied, increasing maternal age, increasing number of previous cesarean scar and increasing hemoglobin levels were associated with increased risk of hypotension