Comparison of the hemodynamic changes between preeclamptic and normotensive parturients who underwent cesarean section under spinal anesthesia at North Showa zone public hospitals, Oromia region, Ethiopia, 2022: a prospective cohort study.

BACKGROUND: Spinal anaesthesia complicates maternal hemodynamic and may expose the parturient to dangerous cardiovascular problems. Up to 7% to 89.2% of pregnant women can suffer from spinal anaesthesia-related hypotension. The aim of this study to compare the hemodynamic changes between preeclamptic and normotensive parturients who underwent caesarean section under spinal anaesthesia at North Showa Zone Public Hospitals, Oromia Region, from February 15 to May 15, 2022. METHODS: A prospective cohort study was conducted on a total of 140 parturients (70 in each group) who underwent cesarean delivery under spinal anesthesia. The study participants were chosen using a consecutive sampling technique. Data were collected from patient charts and intraoperative observations and entered into the Epi Data software version 4.6 and exported to the Statistical Package for the Social Sciences version 25 software. Hemodynamic change = (baseline value-current value/baseline value) * 100. The independent t-test, Mann-Whitney U test, two ways mixed ANOVA, chi-square, and Fisher's exact test was used to analyze the data as appropriate. A P < 0.05 was statistically significant. RESULTS: The mean percentage change in SBP, DBP, and MAP after spinal anaesthesia was a statistically significant difference between the normotensive and preeclamptic groups, except MAP at 15 min was comparable between the two groups with p = 0.638. The proportion of preeclamptic parturients who develop hypotension was 47%, compared to 74% of normotensive parturients, and the RR of developing hypotension, if participants were preeclamptic, was 0.63, with a 95% confidence interval of 0.412 to 0.978 and a p = 0.039. The mean change in heart rate during the first 15 min was comparable between the groups. CONCLUSION: In contrast to normotensive parturients undergoing caesarean section under spinal anaesthesia, our study found that the hemodynamic change was lower in preeclamptic parturients. The proportion of preeclamptic women who develop hypotension was 47%, compared to 74% of normotensive parturients.

Incidence and predictors of postoperative severe acute pain within 24 hours after cesarean section performed under spinal anesthesia at public hospitals in West Shoa, Ethiopia, 2022 prospective cohort study.

Background: Acute postoperative pain is common after a caesarean section; the mother suffers severe pain in the first 24 h after the caesarean section compared to spontaneous birth. Failure to discover predictors of pain leads to maternal dissatisfaction, increased expenses, and restricted movement; it increases the risk of deep vein thrombosis, lengthens hospital stays, and decreases social intimacy. Methods and materials: An institution-based prospective cohort study was conducted among 422 women who went to undergo caesarean sections under spinal anaesthesia at public hospitals in West Shoa from 30 July to 30 October. Participants were selected by systematic random sampling. Data were collected by a structured questionnaire, and the collected data were entered into SPSS version 20 and exported into STATA 64 for analysis. The results were presented in tables and figures. Risk factors were assessed by Poisson regression with a robust standard error. Results: The overall incidence of severe postoperative pain after a caesarean section performed under spinal anaesthesia within 24 h of follow-up was 50.4% [95% confidence interval (CI): 40.7, 60.1]. Preoperative anxiety risk ratio 1.7 (95% CI: 1.4-2.0), preoperative pain risk ratio 1.3 (95% CI: 1.0-1.48), type of incision risk ratio 11.3 (95% CI: 1.1-1.6), spinal anaesthesia without adjuvants risk ratio 4.1 (95% CI: 1.5-10.9), and duration of surgery risk ratio 1.5 (95% CI: 1.3-1.8) were found to be predictors for postoperative severe acute pain after caesarean section performed under spinal anaesthesia. Conclusion: In this study, the overall incidence of severe acute pain after a caesarean section under spinal anaesthesia was high. Preoperative fear, duration of the operation, preparatory pain, spinal anaesthesia without the use of adjuvants, and the type of incision were risk factors for severe acute postoperative pain after a caesarean section under spinal anaesthesia.

Obstetrics mortality and associated factors in intensive care unit of Addis Ababa public hospital in, 2020/21: A hospital based case control study.

Background: In low-income nations like Ethiopia, the rate of obstetric death in intensive care units is significant. The indications of admission are Preeclampsia/Eclampsia, postpartum hemorrhage, and puerperal sepsis but, patient outcomes subsequent to intensive care unit admission are sparse. The aim of this study is to assess factors associated with obstetrics mortality in Intensive Care unit. Methods: A hospital based unmatched case control study was conducted on obstetrics patients admitted to Addis Ababa Public hospital's intensive care unit from October 2018 to November 2020. Multivariable logistic regression analysis was done; Odds Ratio and Confidence Interval (OR and 95% CI) were computed using SPSS version 26. P value < 0.05 was taken as statistically significant. Result: Obstetrics mortality in intensive care unit was high and accounts 27% from the total intensive care unit admission. Severe pre-eclampsia AOR: 6.33; 95% CI: 2.25-17.79, puerperal sepsis AOR: 4.51; 95% CI: 1.68-12.15, age ≥35 years AOR: 4.09; 95% CI: 1.42-11.77, absence of antenatal care: AOR: 3.74; 95% CI: 1.03-13.5, maternal coexisting diseases AOR: 5.2; 95% CI: 2.22-12.16, and severely decrease of consciousness at admission AOR: 3.78; 95% CI: 1.21-11.79 were significantly associated with obstetrics mortality in Addis Ababa Public Hospitals intensive care unit. Conclusion: and Recommendation: Maternal age ≥35 years, loss of antenatal care, puerperal sepsis, severe pre-eclampsia, pre-existing medical comorbidities and severe decrease level of consciousness during ICU admission were the most significant factors associated with obstetrics mortality. It is recommended that all pregnant women should have antenatal care so that preeclampsia and maternal comorbidities will be early diagnosed and treated.