Incidence and risk factors of hypotension in cesarean section patients under spinal anesthesia at a referral hospital in Mogadishu, Somalia.

BACKGROUND

Spinal anesthesia-induced hypotension is a common complication during cesarean sections, with significant implications for maternal and neonatal outcomes. However, data on the incidence and risk factors of hypotension in Africa, notably in Somalia, are limited. This study aimed to investigate the incidence and risk factors of hypotension in cesarean section patients under spinal anesthesia at a referral hospital in Mogadishu, Somalia.

METHODS

A cross-sectional study was conducted at a referral hospital in Mogadishu, Somalia, involving 320 patients who underwent cesarean section under spinal anesthesia using a systematic random sampling technique. Data on sociodemographic, medical history, and anesthetic characteristics were collected using a questionnaire. Descriptive statistics were used for frequencies and percentages. Chi-square tests and logistic regression were used to identify the risk factors associated with hypotension after spinal anesthesia at α = 0.05.

RESULTS

Among the 320 participants, the incidence of hypotension after spinal anesthesia during cesarean section was 78.1% (95%CI = 73.8-82.5]. In the multivariable model, five variables were found to be significantly associated with hypotension after spinal anesthesia in patients undergoing cesarean section: Mothers with BMI above 25 kg/m (AOR = 2.65, 95% CI = 1.39-5.04), mothers who had no hypertension during pregnancy (AOR = 6.00, 95% CI = 2.50-14.40), mothers who did not take preload IV fluid (AOR = 3.06, 95% CI = 1.22-7.66), mothers who did not take ephedrine medication (AOR = 8.84, 95% CI = 4.10-19.05), patients below 11 g/dl of preoperative hemoglobin (AOR = 2.52, 95% CI = 1.25-5.05).

CONCLUSIONS

This study found a high incidence of hypotension among mothers undergoing cesarean section under spinal anesthesia in Mogadishu. Significant risk factors included high BMI, low preoperative hemoglobin, lack of preload and absence of ephedrine use. Targeted interventions-such as preoperative risk screening, hemoglobin optimization, and prophylactic ephedrine use-are recommended to reduce the occurrence of spinal anesthesia-induced hypotension.