Abdominal circumference and its relationship with the incidence of hypotension during elective cesarean section under spinal anesthesia at public hospitals of Addis Ababa, Ethiopia, 2024.

BACKGROUND

Hypotension is a common complication in pregnant mothers during cesarean section after spinal anesthesia. Identifying the association between abdominal circumference and the likelihood of developing hypotension following a cesarean delivery while under spinal anesthesia can facilitate preventing hypotension.

OBJECTIVES

This study aims to assess the relationship between the abdominal circumference of pregnant women and the occurrence of hypotension during cesarean section under spinal anesthesia at public hospitals in Addis Ababa, Ethiopia, 2024.

METHOD: A prospective observational study through a simple systematic random sampling technique was conducted on 360 pregnant mothers who underwent elective cesarean section under spinal anesthesia from January 7, 2024, to March 30, 2024. Data was collected using a data collection questionnaire and checklist. The data was entered using Epi Info 7.2 and exported into SPSS 26. The Patients were categorized by their median abdominal circumference, < 102 cm (small abdominal circumference (SAC)) and ≥102 cm (large abdominal circumference (LAC)). The chi-square test was used to compare the numerical and percentage representations of the categorical variables. Descriptive analyses, bivariate logistic regression, and multivariate regression were carried out. In multivariate variables, p ≤ 0.05 was used as statistical significance, and an odds ratio was used for the strength of association.

RESULT: Among 360 study subjects, the incidence of post-spinal hypotension was 76.67% with 95%CI [71.9-80.9]. The Large abdominal circumference (LAC) group showed a greater maximal decrease in MAP from baseline compared to the SAC group (LAC 85.6% and SAC 63.3%, p < 0.001). The identified associated factors with the incidence of hypotension were LAC (AOR = 2.98, 95% CI [1.57, 5.65] p = 0.01); BMI > 25 kg/m2 (AOR = 2.3, 95%CI [1.16-4.6], P = 0.018); baby weight> 4 kg (AOR = 11.41 95%CI [2.0-64.86] P = 0.006); sensory block of above T6 level (AOR = 2.22, 95%CI [1.12, 4.42]) p = 0.023) and greater than 500 ml preload given (AOR = 0.42 [95%CI 0.2-0.89] p = 0.023.

CONCLUSIONS

The study found that there was a high incidence of hypotension during elective cesarean section under spinal anesthesia and a significant difference between the SAC and LAC groups. Also, the study found that the independent factors significantly associated with the incidence of hypotension were LAC, higher BMI, higher baby weight, and higher sensory block level, while greater preload volume was protective.