Prevalence and factors associated with hypotension after spinal anesthesia during cesarean section at public hospitals in Harar town, Eastern Ethiopia

Background Spinal anesthesia is a type of regional anesthesia that has been practiced for obstetric anesthesia since the beginning of the 20th century. Despite the simplicity and lower maternal mortality risk, compared to general anesthesia, spinal anesthesia is linked to different adverse effects, of which hypotension is the most common complication. Comprehensive data are scarce on hypotension during spinal anesthesia and its associated factors in this study area. Objective This study aimed to determine the prevalence and factors associated with spinal anesthesia-induced hypotension during cesarean section at Hiwot Fana Comprehensive Specialized University Hospital and Jugal General Hospital, Harar, Ethiopia, November 20, 2024- January 20, 2025. Method An institution-based cross-sectional study was conducted among 389 mothers who underwent cesarean section. Participants were selected using simple random sampling. Data were collected using a pretested structured questionnaire and supplemented by medical record review. Data were entered into EpiData 3.1 and analyzed using SPSS version 26. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with hypotension. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported, with variables having a p-value <0.05 in the multivariable analysis considered statistically significant. Result Data from 388 participants were analyzed. The overall prevalence of spinal anesthesia-induced hypotension was 59.28% (95% CI: 54.40%–64.20%). In the multivariable logistic regression analysis, the odds of developing post-spinal hypotension were significantly higher among mothers delivering newborns weighing ≥2.5 kg (AOR=6.89; 95% CI: 2.99–15.91), those experiencing an intraoperative estimated blood loss between 500 and 1000 mL (AOR=2.87; 95% CI: 1.53–5.40), patients maintained in a supine position immediately before anesthetic induction (AOR=2.02; 95% CI: 1.24–3.27), and procedures with a total surgical duration exceeding 1 hour (AOR=1.97; 95% CI: 1.25–3.11). Conclusion The prevalence of spinal anesthesia-induced hypotension during cesarean section among pregnant mothers was high. Newborn weight, being positioned supine before spinal anesthesia, greater than 1 hr duration of surgery, and estimated blood loss are factors associated with hypotension after spinal anesthesia. Recognizing these high-risk profiles and optimizing perioperative care protocols, such as managing surgical timelines, monitoring fluid volume, and utilizing left-lateral positioning, may serve as valuable supportive considerations for managing maternal hemodynamic stability.