Is the Emergency Cesarean Section associated with Hypotension? Retrospective Analysis of 80 Patients Undergoing Elective or Emergency Cesarean Section under Spinal Anesthesia

INTRODUCTION: While CS is associated with several intraoperative and postoperative complications, the risk of the hemodynamic changes in case of an emergency CS is usually underestimated. The lack of adequate patient preparation before anesthesia and insufficient time to correct the volume depletion before anesthesia are common issues in emergency CS. The present study aimed to compare the hemodynamic changes in patients undergoing elective or emergency CS.
METHODS: All consecutive patients undergoing CS with spinal anesthesia in a tertiary stage hospital were enrolled in this retrospective study. Patients were divided into two groups according to the emergency of the CS as Elective CS group and emergency CS groups. Elective CS patients received routine volume replacement before surgery, whereas emergency CS patients received volume replacement according to the operator’s decision. The difference in the hemodynamic parameters throughout the surgery between the elective and emergency CS groups was the primary outcome measure of this study.
RESULTS: The amount of the intravenous fluid administered before surgery was significantly lower in the emergency CS group compared to the elective CS group (650±280 ml vs. 1430±460 ml, p<0.01). A significant drop occurred in systolic, diastolic, and mean arterial pressure early at the 5th minute of anesthesia in patients undergoing emergency CS. However, no significant change was observed in the elective CS group concerning the systolic, diastolic, and mean arterial pressure and heart rate.
DISCUSSION AND CONCLUSION: In contrast to the women undergoing elective CS, a significant drop occurs in systolic, diastolic and mean arterial blood pressure following the implementation of the spinal anesthesia in patients undergoing emergency CS. Rapid evaluation of the volume status and intravenous volume replacement may prevent the reduction of the arterial pressure in patients undergoing emergency CS.