A Comprehensive Evaluation of Maternal Complications Linked to Spinal Anesthesia During Cesarean Section A Hospital-Based Study

Abstract

Background: Spinal anesthesia is widely considered the preferred anesthetic technique for cesarean section due to its rapid onset, maternal safety profile, and minimal neonatal drug exposure. However, it is frequently associated with maternal complications such as hypotension, shivering, nausea, vomiting, and post-dural puncture headache (PDPH). These complications may be influenced by several maternal characteristics and comorbidities, and they can indirectly affect neonatal outcomes. A comprehensive evaluation of these complications is essential to guide preventive strategies and improve perioperative care in obstetric anesthesia.

Objectives: To determine the frequency of maternal complications associated with spinal anesthesia during cesarean section and to identify predictors of major complications, including hypotension, PDPH, and shivering, and to assess associated neonatal outcomes.

Methodology: A hospital-based cross-sectional study was conducted at Hayatabad Medical Complex over six months with a sample size of 184 parturients undergoing cesarean section under spinal anesthesia. A non-probability convenience sampling technique was used. Data were collected using a structured proforma including maternal demographics, comorbidities, intraoperative events, hemodynamic changes, and neonatal APGAR scores. Logistic regression analyses were performed to identify predictors of hypotension, PDPH, and shivering. APGAR scores at 1 and 5 minutes were analyzed using t-tests and chi-square tests. A 24-hour postoperative complication table was constructed to document hypotension, bradycardia, shivering, nausea, vomiting, and PDPH. Data were analyzed using SPSS version 26, with a significance level of p < 0.05.

Results: The most common maternal complication was hypotension (45.6%), followed by shivering (31.0%), nausea/vomiting (22.8%), and PDPH (9.2%). Regression analysis showed that higher BMI, lower baseline systolic blood pressure, advanced maternal age, and comorbidities such as gestational hypertension were significant predictors of hypotension (p < 0.05). Younger age and low BMI were predictive of shivering (p < 0.05), whereas younger maternal age and needle size were associated with PDPH. Most neonates had reassuring APGAR scores (≥7) at 1 and 5 minutes, though severe maternal hypotension correlated with lower APGAR scores at 1 minute (p < 0.05). The 24-hour postoperative complication table revealed shivering, nausea, vomiting, and PDPH as the most commonly reported postoperative events.

Conclusion: Maternal complications following spinal anesthesia during cesarean section are common, with hypotension being the most frequent and clinically significant. Predictors identified through regression analysis highlight the importance of individualized risk assessment, optimization of maternal health parameters, and vigilant intraoperative monitoring. Neonatal outcomes were largely favorable, though closely linked to maternal hemodynamic stability. Strengthening perioperative management protocols based on these predictors may substantially reduce the incidence of adverse events and improve both maternal and neonatal outcomes.