Period prevalence and risk factors for spinal anaesthesia-induced hypotension in obstetric patients at a tertiary hospital in the Eastern Cape

Abstract

Background: Spinal anaesthesia (SA) is the preferred anaesthetic technique for caesarean sections (CS) due to its efficacy and safety. However, spinal anaesthesia-induced hypotension (SAIH) remains a significant concern, contributing to maternal morbidity and mortality. The prevalence and impact of this complication in resource-limited settings, such as Dora Nginza Hospital (DNH) in the Eastern Cape, South Africa, are not well documented.
Methods: This retrospective, cross-sectional study reviewed the 340 anaesthetic charts of obstetric patients undergoing CS under SA from January to June 2023. Hypotension was defined as a systolic blood pressure (SBP) < 90 mmHg and/or SBP < 80% from baseline. Demographic, procedural, and clinical data were collected to determine the SAIH prevalence.
Results: The prevalence of SAIH was 53%. Increased maternal age, higher baseline SBP, and hypertensive disorders were significantly associated with hypotension (p < 0.05). Vasopressor therapy was administered in 47% of cases; however, 21% of hypotensive patients did not receive vasopressor support, highlighting a discrepancy between hypotension prevalence and intervention. Factors such as CS indication, patient positioning, and local anaesthetic dose were also evaluated, but showed variable significance.
Conclusion: SAIH is a prevalent and under-addressed issue in this setting. The findings highlight the need for standardised protocols and early intervention strategies, particularly regarding vasopressor administration, to mitigate the risks associated with SA for CS in resource-limited environments.