Incidence of, and risk factors for, hypotension during spinal anesthesia for cesarean section at the Kenyatta National Hospital.

Abstract

Objective - This study was undertaken to determine the incidence of, and risk factors for, hypotension during spinal anaesthesia for Cesarean Section at Kenyatta National Hospital. Design - A cross-sectional, prospective, non-randomized observational study. Setting - Kenyatta National Hospital maternity theatres. Subjects- Women having spinal anaesthesia for emergency or elective Caesarean Section. Methods- An initial blood pressure was taken immediately after the injection of local anesthetic and then every 2.5 minutes for the first 10 minutes. Observation of occurrences or non occurrences of hypotension (systolic blood pressure equal to or below 90 mmHg) within the first 10 minutes of the routine anaesthetic care was noted. Results- In this study where 112 full-term pregnant women received successful spinal anesthesia for Cesarean Section from February 1 to April 31, 2009, at The Kenyatta National Hospital, the incidence of hypotension was 64%. The factors associated with the development of hypotension in the present study included maternal height < 155 em (p.value =0.008) and sensory level higher than T5 (p-value =0.007). The main preventive strategies used to reduce the incidence of hypotension in mothers undergoing elective or emergent cesarean section included left uterine displacement (100%), prophylactic ephedrine (82.1 %), and fluid loading with crystalloids or colloid (83.0%,17%) respectively. Although nausea and vomiting often accompanies hypotension in the parturient, the incidence in this study was only 20%. Conclusion-We found in this study,that the incidence of hypotension in at The Kenyatta National Hospital was 64.%,and that the factors associated with development of hypotension included maternal height < 155 em and sensory level higher than T5