Spinal-Induced Hypotension in Preeclamptic and Healthy Parturients Undergoing Cesarean Section

• Published in: Open access Macedonian journal of medical sciences 2019-03, Vol.7 (6), p.996-1000
• Main Authors: Sivevski, Atanas, Ivanov, Emilija, Karadjova, Dafina, Slaninka-Miceska, Maja, Kikerkov, Igor
• Format: Article
• Language: English
• Subjects: Clinical Science
• ISSN: 1857-9655; 1857-9655
• DOI: 10.3889/oamjms.2019.230

There is a widespread belief that spinal anaesthesia in patients with preeclampsia might cause severe hypotension and decreased uteroplacental perfusion. This study aimed to evaluate the incidence and severity of spinal induced-hypotension in preeclamptics and healthy parturients. Total of 78 patients (40 healthy and 38 preeclamptic) undergoing a C-Section with spinal anaesthesia were included. Spinal anaesthesia was performed with a mixture of 8-9 mg isobaric 0.5% bupivacaine, 20 mcg fentanyl and 100 mcg morphine (total volume 2.2-2.4 ml). Blood pressures (BP)-SBP, DBP, MAP were recorded non-invasively before performing spinal anaesthesia and at 2.5 minutes after a spinal puncture. The BP falls (%) from baseline were significantly greater in the healthy parturients compared to those with preeclampsia (25.8% ± 10.1 vs 18.8% ± 17.0 for SBP, 28.5% ± 8.8 vs 22.5% ± 10.4 for DBP, and 31.2% ± 14.2 vs 18.2% ± 12.6% for MAP, p < 0.05). The incidence rate of hypotension in the preeclamptics was 25% compared to 53% in healthy parturients (p < 0.001). Higher doses of vasopressors both ephedrine (16.5 ± 8.6 vs 6.0 ± 2.0 mg) and phenylephrine (105 ± 25 mg) in the healthy women were required. There was no need for phenylephrine treatment in the preeclamptic group. This study showed that the incidence and severity of spinal-induced hypotension in preeclamptic patients are less than in healthy women. The use of low dose spinal anaesthesia also contributed to this statement.