Determination of Incidence and Risk Factors of Hypotension Following Spinal Anesthesia During Cesarean Delivery in Patients With Preeclampsia: A Prospective Observational Study

Background Preeclampsia is associated with high-risk pregnancies and significant maternal morbidity. Although the incidence of hypotension is lower in preeclamptic women, its occurrence can lead to adverse maternal outcomes due to altered vascular physiology. This study aimed to determine the incidence of hypotension following spinal anesthesia in preeclamptic women and to identify associated demographic, obstetric, and clinical risk factors. Methods This prospective observational study included 180 preeclamptic women undergoing cesarean section under spinal anesthesia. Hypotension was defined as systolic blood pressure <100 mmHg. Univariate logistic regression was performed to identify potential risk factors, and variables with p<0.20 were included in multivariable logistic regression to adjust for confounding. Results The incidence of hypotension was 28.33% (51/180). On univariate analysis, early-onset preeclampsia (≤34 weeks), multiple gestation, and lower hemoglobin levels were associated with increased risk of hypotension. In multivariable analysis, anemia remained an independent predictor. Women with hemoglobin 7-9.9 g/dl had 3.15 times higher odds (95% CI: 1.33-7.45; p=0.009), and those with hemoglobin 10-10.9 g/dl had 2.44 times higher odds (95% CI: 1.02-5.84; p=0.044) of hypotension compared to those with hemoglobin >11 g/dl. Early-onset preeclampsia also showed increased odds (AOR 1.71; 95% CI: 0.82-3.56), without statistical significance. Conclusion Hypotension following spinal anesthesia occurs in a substantial proportion of preeclamptic women. Optimization of hemoglobin levels and careful perioperative monitoring may help reduce the risk of hypotension and improve maternal outcomes.