Predictors, Hemodynamic Responses, and Management of Hypotension Following Spinal Anesthesia in Obstetric and Gynecologic Patients the Role of Comorbidities

Abstract

Background: Hypotension is one of the most frequent and clinically significant complications following spinal anesthesia, particularly among obstetric and gynecologic patients. The presence of comorbidities such as hypertension, diabetes mellitus, anemia, and obesity may further predispose patients to severe hemodynamic instability. Early identification of predictors and timely management strategies are essential to improving perioperative outcomes in this population. Objective: To evaluate the predictors, hemodynamic responses, and management practices associated with hypotension following spinal anesthesia in obstetric and gynecologic patients, with specific emphasis on the role of patient comorbidities. Methodology:

A cross-sectional study was conducted at Hayatabad Medical Complex over a duration of four months. A total of 162 patients were selected using Cochran’s formula. Data were collected through structured clinical assessment forms, including demographic details, comorbidities, anesthetic characteristics, hemodynamic measurements, and management interventions. Statistical analysis was performed using SPSS Version 26, applying descriptive and inferential statistics to identify significant predictors of hypotension.

Results:

Among the 162 participants, the highest distribution was observed in the 26–35 years age group (43.8%), with 64.2% females. The overall incidence of hypotension following spinal anesthesia was 61.1%. Significant predictors included higher BMI (p<0.05), low baseline systolic blood pressure (p<0.05), ASA III status (p<0.01), and higher spinal anesthetic dosage (p<0.05). Comorbidities such as hypertension (22.8%), diabetes mellitus (18.5%), anemia (33.3%), and obesity (29.6%) were significantly associated with the development of hypotension. Most hypotensive episodes occurred within the first 10 minutes post-anesthesia. Management strategies included crystalloid co-loading (92.5%), vasopressor administration (58%), and left-lateral tilt positioning for obstetric cases (46%), all of which effectively stabilized hemodynamics.

Conclusion:

Hypotension following spinal anesthesia remains highly prevalent among obstetric and gynecologic patients, especially those with underlying comorbidities. Identifying predictors such as BMI, baseline systolic blood pressure, ASA class, and anesthetic dosage can help clinicians anticipate and manage hemodynamic instability more effectively. Tailored preventive strategies and vigilant monitoring are essential to improving perioperative safety and maternal outcomes.