Comparison of Hemodynamic Response and Fetal Outcome Following Spinal Anesthesia, between Normotensive and Severely Preeclmptic Parturients Undergoing Elective Cesarean Section: A Prospective Study
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Date
2019-12
Authors
Desta, Mele
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Publisher
Addis Abeba University
Abstract
Background: Maternal hypotension is a common complication after spinal anesthesia resulting in adverse maternal and fetal outcomes. Theoretical knowledge claims that it is more common in severely preeclamptic parturients.
Object ive: To compare hemodynamic changes and neonatal outcome in normotensive and severe preeclamptic parturients undergoing elective cesarean section under spinal anesthesia.
Methodol ogy: A prospective cohort study was conducted at St. Paul’s Millennium Medical College hospital from July 1 to December 20, 2019 on 84 American Society of Anesthesiologists (ASA) II and III parturients divided in to two groups (42 severely preeclamptic group and 42 normotensive group) who underwent elective Cesarean delivery under spinal anesthesia were involved in the study. After preloading with crystalloids, a 0.5% isobaric bupivacaine of 12.5 mg was used for spinal anesthesia. At the completion of the block, vital signs were recorded every three minutes till 20 minutes after spinal anesthesia and every five minutes then after. Hypotension was defined as a 30% decrease in mean blood pressure in both groups. Vasopressors, total fluids taken intraoperatively, neonatal Apgar scores were recorded. Chi- square test was used to calculate the incidence of hypotension between groups; both paired and unpaired t- tests were also used to calculate the percent fall of both blood pressure and heart rate from corresponding baselines of each group and intergroup respectively, after checking the distribution of data using Shapiro wilks test and histogram inspection in SPSS version 20 software.
Resul t s: After induction of spinal anesthesia; systolic blood pressure, diastolic blood pressure and mean blood pressure decreased in both groups, but more in the normotensive groups as compared to the preeclamptic one, in the first 9 minutes. The incidence of hypotension (over a period of 30minutes after spinal anesthesia) in the preeclamptic patients (31% ) was less than that of the healthy parturients (59.5% ), despite the former receiving smaller volumes of intravenous fluids. There was no statistically significant difference in heart rate of both groups before and after the induction of spinal anesthesia. The 5th minute Apgar score recordings were also comparable between the groups.
Concl usion: Our study showed that the incidence and magnitude of spinal anesthesia-
induced hypotension was less in severely preeclamptic parturients than healthy parturients who underwent elective cesarean delivery under spinal anesthesia.
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Keywords
Spinal Anesthesia