Assessment of the magnitude and risk factors of post spinal relevant haemodynamics associated with caesarean section in Gondar university hospital, Northwest Ethiopia

Abstract

Background and Context: Although there are significant differences in maternal mortality rates between developed and developing countries, it appears that the predisposing factors for anaesthesia related maternal mortality are similar. Maternal haemodynamics to varying degrees during regional anaesthesia particularly for spinal anaesthesia for caesarean section remain a common clinical problem. In severe cases; they can have detrimental effects on both mother (unconsciousness and pulmonary aspiration) and neonate (hypoxia, acidosis, and neurological injury). Numerous prophylactic strategies have been investigated and different adjuvants been tried out for management of spinal haemodynamics associated with caesarean section (SHACS) so that marked hypotension can be reduced and complications prevented. Aims and Objectives: The present study was carried out to determine magnitude of post spinal haemodynamics during caesarean section and identify factors associated with relevant maternal hypotension while at the same time providing clinically relevant factors associated with SHACS. Materials and Methods: After obtaining approval from the institutional research board of university of Gondar, this cross sectional clinical study was conducted among 143 pregnant mothers who underwent caesarean section from January 29 – April 15, 2014. Simple random sampling technique was conducted and patients fulfilling the inclusion criteria were included in the study. Maternal hemodynamic changes and the severity were assessed within 60 minutes after spinal injection. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) of parturient were recorded at the admission to operating room (preanaesthetic baseline), immediately after anesthesia (displayed as time 0), and minutes 3, 5, 15, 20, 25, 30, 35, and 60 after spinal injection and the records was compared with baseline measures. The primary outcome of the study is defined as the incidence of relevant maternal hypotension. Secondary outcomes included changes in blood pressure, spinal injection to hypotension interval, the prolongation of hypotension, bradycardia, nausea, vomiting, shivering, and fainting. Statistical analysis was performed by using the statistics program SPSS window. Odds ratio, 95% confidence interval, p-value (p < 0.05), bi-variant and multi-variant logistic regression was computed to identify associated factors and to determine the strength of the association. Results: The incidence of relevant maternal hypotension was 55.9 %. Sever hypotension was detected in 31patients (21.7%) out of those who had relevant hypotension. There was a highly significant relationship for Sensory block height became above T4 at 10 minute post SpA p_<0.001 (AOR= 5.340; 95% CI: 2.235 - 12.762), Elective degree of urgency involved P_ 0.038 (AOR=0.207; 95% CI: 0.047 - 0.918) and Dose of local anaesthetic more than 2.5 ml or > 12.5 mg of bupivacaine, P_0.001 (AOR= 7.815; 95% CI: 2.338 – 26.12). Conclusion and Recommendation: Lowering the intrathecal dose of spinal anesthesia seems to be a useful technique to reduce the incidence of hypotension and better preserves maternal hemodynamic stability. The study showed that the incidence of relevant hypotension will increase when the analgesic block level become higher than T4 dermatome within 10 minutes. Depending on the degree of urgency, a parturient with an emergency base for caesarean delivery may be a useful tool to predict relevant hypotension during spinal anesthesia. The hospital management and responsible clinicians of GUH need to minimize the incidence of post spinal relevant hypotension by adquate preotimization and taking to account avaliable options.