Introduction: The current choice of anesthesia for the cesarean section is spinal anesthesia. However, hypotension is the major complication. If promptly not recognized and treated, it increases the morbidity and mortality of the mother and fetus. This study was conducted to evaluate the rate of pre-delivery hypotension and risk factors following spinal anesthesia for cesarean section at the National Referral Hospital in Bhutan. Methods: A cohort study was conducted from 1st October 2018 to 30th June 2019 on 350 women undergoing cesarean section under spinal anesthesia. Pre-delivery hypotension was defined as systolic blood pressure < 100 mm Hg. The association of factors for hypotension was tested using multivariable binary logistic regression using a forward stepwise model. A p-value < 0.05 was considered significant. Results: The rate of pre-delivery hypotension was 74.6 % (n=261). History of hypertension during pregnancy (Adjusted OR 0.25, [0.11-0.60], p=0.013), prophylaxis use of ephedrine (Adjusted OR 0.45, [0.22-0.92], p= 0.024) and ondansetron (Adjusted OR 0.43, [0.22-0.82], p= 0.010),longer preoperative fasting duration (Adjusted OR 1.12, [1.01-1.21], p=0.024,), sensory block level <= T4 (Adjusted OR 3.4, [1.8-6.4], p=<0.001) and baseline systolic blood pressure less than or equal to 120 mmHg (Adjusted OR 2.8, [1.5-5.1], p=0.001) were significant risk factors. Conclusions: This study conduces that the rate of pre-delivery hypotension following spinal anesthesia in a cesarean section was high among women undergoing cesarean section. It is alarming as around two-third of women and fetus undergoing cesarean section under spinal anesthesia are at risk of consequences of hypotension. Most of the risk factors in the study are modifiable. The study suggests that if the anesthesia provider intervenes in managing the modifiable risk factors and treat hypotension promptly, it can help reduce the risk of women and fetus to spinal hypotension consequences.
Background The practice of neuraxial labor analgesia (NLA) as a mode of pain relief was introduced in Bhutan in 2016 despite it being in practice for more than five decades. There is a lack of data on NLA in Bhutan. Therefore, this study describes the use of NLA and its outcome over 4 years in Bhutan. Methods A retrospective descriptive study was conducted from 1 January 2018 to 31 December 2021. The data were obtained from the Anesthesia Department, medical records, admission forms, and birth‐registers. A total of 524 women were included. Data were recorded using 2021 Microsoft Excel version 16.57 (22011101) and analyzed using Epi Info 7.2.5.0. Categorical data were summarized using frequencies and percentages. Continuous data were summarized using mean and standard deviation. Results The incidence of NLA usage was 3.5% (524/15,119). Most women were between 21 and 30 years (67.2%). Modes of delivery following NLA were spontaneous vaginal delivery, cesarean section, and assisted vaginal delivery 63.4%, 18.4%, and 18.3%, respectively. Non‐reassuring fetal status (37.5%) and failed progression of labor (36.5%) were the leading indications of cesarean section. The primary reason for assisted vaginal delivery was poor maternal effort (55.2%). Neonates of the mother who received neuraxial analgesia had neonatal jaundice in 8%, neonatal intensive care unit admission in 0.76%, and Apgar score less than 7 in 5.1% and 0.2% at 1 and 5‐min, respectively, after birth. Conclusion Although NLA is safe for both mothers and babies, its use is low in Bhutan. The probable reason for the low incidence could be a shortage of anesthesiologists, cultural beliefs, and lack of awareness. The Ministry of Health and the Department of Anesthesia should work together to improve the service.
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