College of Medicine and Health Science

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    INCIDENCE AND PREDICTORS OF HYPOTENSION AFTER SPINAL ANESTHESIA AMONG PREECLAMPTIC MOTHERS WHO UNDERWENT CESAREAN SECTION IN SELECTED TEACHING HOSPITALS OF SOUTHERN ETHIOPIA, 2024: A MULTICENTER PROSPECTIVE COHORT STUDY
    (hawassa university, 2004-10) ADISU NEGESA
    Background: Preeclampsia is the most common cause of fetal and maternal problems in developing nations. The incidence of hypotension after spinal anesthesia in preeclamtic mothers during cesarean section ranges from 7-89%. In patients with severe preeclampsia, anesthesia professionals are frequently discouraged from using spinal anesthesia due to the risk of severe hypotension. Objectives: To assess the incidence and predictors of hypotension after spinal anesthesia among preeclamptic mothers who underwent cesarean section in selected teaching hospitals in southern Ethiopia. Methods and materials: A multicenter prospective cohort study was conducted among 140 mothers with preeclampsia in 6 randomly selected teaching hospitals in southern Ethiopia from February 1 to April 30, 2024. Data were entered into Epidata version 4.6 and exported into SPSS version 27 for analysis. The variables with a p-value of <0.25 in the bivariable logistic regression were inserted into the multivariable logistic regression. Multivariable logistic regression analysis identified the independent predictors of hypotension after spinal anesthesia. The degree of association was assessed using the Adjusted Odds Ratio (AOR) with a p-value of <0.05 being considered statistically significant. Results: The overall incidence of hypotension after spinal anesthesia was 50.7%. The dose of bupivacaine >10 mg (AOR=6.28, 95% CI; 1.96-20.06), spinal puncture to baby delivery duration >10 minutes (AOR=5.0, 95%CI; 1.48-16.86), estimated blood loss >500 ml (AOR=5.24, 95% CI; 1.12-24.46) and duration of surgery ≥40 minutes (AOR=5.81, 95% CI; 1.03-32.55) were identified predictors of hypotension after spinal anesthesia. Conclusion and recommendation: The incidence of hypotension after spinal anesthesia in mothers with preeclampsia was high. Therefore, professionals must use small doses of bupivacaine, reduce spinal puncture to baby delivery time, minimize blood loss, and decrease surgery duration since they are predictors of hypotension after spinal anesthesia.
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    PREVALENCE AND FACTORS ASSOCIATED WITH ADVERSE NEONATAL OUTCOMES AMONG CESAREAN DELIVERIES AT PUBLIC HOSPITALS IN HAWASSA CITY, SIDAMA REGION, ETHIOPIA
    (Hawassa University, 2024-06) TAMIRU RIKIBA
    Background: Cesarean deliveries are linked to higher risks of adverse neonatal outcomes compared to spontaneous vaginal births. In Ethiopia, comprehensive data on these outcomes and associated factors is lacking. Understanding these issues in hospitals is crucial for improving maternal and neonatal care. Objective: This study aimed to assess prevalence and factors associated with adverse neonatal outcomes among cesarean deliveries at public hospitals in Hawassa city, Sidama region, Ethiopia. Method and material: a facility based retrospective cross-sectional study was conducted at two public hospitals in Hawassa city from April 1 to 30, 2024, analyzing 522 hospital medical records of mothers who delivered by CS from Jan 2023 to Aug 2024. Data were collected using a structured data extraction checklist via kobocollect 4.0, and Simple random sampling technique was employed to select study participants. Data were analyzed using SPSS version 27, employing Binary and Multiple Logistic regressions to identify factors associated with adverse neonatal outcomes. Statistical significance was stated at p-value<0.05, with adjusted odds ratio (AOR) and 95% confidence interval (CI) reported. Result: nearly one-third of newborns delivered through cesarean section developed adverse outcome. Women who had preeclampsia and abruptio-placenta were 2.9 (AOR: 2.9; 95% CI; 1.104, 3.38 and 3.3 times (AOR: 3.3; 95% CI; 1.36, 8.21) more likely to develop an adverse neonatal outcomes compared with those women who did not have the condition respectively. Similarly women who delivered by midline cesarean section were 2.9 times (AOR: 2.9; 95% CI; 1.125, 7.4) more likely to develop adverse neonatal outcomes compared with those women who delivered by lower transverse cesarean section. Women who referred from other facility were 2.8 times (AOR: 2.8; 95% CI; 1.82, 4.4) more likely to develop adverse neonatal outcomes compared with those women who were not referred. Conclusion: prevalence of adverse neonatal outcomes was high in the study area. Preeclampsia, abruptio-placenta, being referred from other health facility, and delivery via midline cesarean section were factors associated with adverse neonatal outcomes. Timely intervention for high-risk pregnancies could help reduce adverse neonatal outcomes.
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