Risk factors for severe hypotension after spinal anesthesia in cesarean sections: a prospective study

Pilco E.R.Q.; Pilco J.L.Q. · Revista Chilena de Anestesia (2025) · DOI: 10.25237/revchilanestv54n6-08

Resumen

Introduction: Spinal anesthesia is the most used neuraxial technique in cesarean sections. Severe post-anesthetic hypotension is an adverse event that can increase maternal-fetal morbidity. Multiple risk factors for hypotension have been reported, but there is no consensus about the most important ones due to the great variability of results in the multiple studies performed. Objectives: Identify the incidence of severe hypotension and its risk factors in cesarean sections with spinal anesthesia. Methods: Prospective observational study in cesarean sections with spinal anesthesia, carried out at the National Maternal Perinatal Institute of Lima (INMP). Data were collected in cesarean sections that met inclusion criteria over a 6-month period. Results: In a sample of 207 pregnant women, incidence of severe hypotension was 26.6%. The risk factors with a significant statistical association were age ≥ 35 years OR 2.135 (95% CI 1.016-4.486 p = 0.045); baseline systolic blood pressure > 110 mmHg OR 2.459 (95% CI 1.034-5.849 p = 0.042); newborn weight < 4,000 g OR 7.081 (95% CI 1.806-27.756 p = 0.005) and anesthesiologist experience < 5 years OR 3.318 (95% CI 1.318-7.969 p = 0.007). Conclusions: The incidence of severe hypotension after spinal anesthesia in cesarean sections is considerable. Maternal age > 35 years, baseline systolic pressure >110 mmHg, newborn weight < 4,000 g and anesthesiologist experience < 5 years were identified as risk factors for severe hypotension.