COMPARISON OF HYPOTENSION INCIDENCE IN GYNECOLOGICAL VS OBSTETRICS SURGERY UNDER SPINAL ANESTHESIA

Abstract

Background: Spinal anesthesia is widely used in obstetric and gynecological surgeries due to its rapid onset and favorable safety profile. However, it is frequently associated with spinal anesthesia-induced hypotension (SAIH), particularly in obstetric patients where pregnancy-related physiological changes—such as increased blood volume, reduced systemic vascular resistance, and aortocaval compression—heighten the risk. SAIH can significantly compromise maternal hemodynamics and fetal outcomes if not properly managed.

Objective: This study aimed to determine the prevalence and severity of spinal hypotension among obstetric and gynecological patients receiving spinal anesthesia and to evaluate the effect of preventive measures such as fluid therapy, vasopressor use, and patient positioning.

Methods: A prospective observational study was conducted over four months at Sheikh Zayed Hospital, Lahore. A total of 100 female patients aged 18–45 years undergoing either cesarean section (n = 50) or gynecological surgery (n = 50) under spinal anesthesia were enrolled. Baseline systolic and diastolic blood pressures were recorded and compared with readings taken at 5- and 20-minutes post-anesthesia. Hypotension was defined as a drop in systolic blood pressure ≥20% from baseline or <90 mmHg. Management strategies, including the use of vasopressors and fluid preloading or coloading, were documented. Data analysis was performed using SPSS, and intergroup comparisons were made using the Mann-Whitney U test.

Results: Blood pressure readings between groups showed statistically significant differences at all measured intervals (p < 0.001). Mean baseline systolic pressure was 128.82 mmHg, which dropped to 107.05 mmHg at 5 minutes and 86.55 mmHg at 20 minutes post-anesthesia. Z-scores ranged from -5.078 to -7.563. Gynecological patients consistently had higher systolic and diastolic values than obstetric patients.

Conclusion: Obstetric patients demonstrated a higher susceptibility to SAIH. Individualized anesthetic plans, including fluid optimization and timely vasopressor use, are essential. Future large-scale studies are warranted to refine preventive protocols and improve perioperative care.