Incidence of Hypotension in Obstetric Patients Undergoing Cesarean Section: Conventional vs. Segmental Spinal Anesthesia at Kassala Al- Saudi Maternity Hospital (July 2025 – December 2025)-A cross sectional study

Incidence of Hypotension in Obstetric Patients Undergoing Cesarean Section: Conventional vs. Segmental Spinal Anesthesia at Kassala Al- Saudi Maternity Hospital (July 2025 – December 2025)-A cross sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Incidence of Hypotension in Obstetric Patients Undergoing Cesarean Section: Conventional vs. Segmental Spinal Anesthesia at Kassala Al- Saudi Maternity Hospital (July 2025 – December 2025)-A cross sectional study Mohaned Abdelrhman Mohamedahmed Halawi, Abdelgadir Mohammed Abdelfatah dafaalla, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8457290/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 14 You are reading this latest preprint version Abstract Background: Hypotension is the most common and significant complication of spinal anesthesia during cesarean section, often resulting in maternal discomfort and reduced uteroplacental perfusion, which may compromise fetal well-being. Conventional spinal anesthesia (CSA) is widely used in Sudan but is associated with high rates of hypotension. Segmental spinal anesthesia (SSA), which targets a more restricted dermatomal block, has been proposed as a technique that may offer improved hemodynamic stability. However, evidence comparing both techniques in Sudanese obstetric practice is limited. Objective: To compare the incidence and severity of hypotension in obstetric patients undergoing cesarean section under CSA versus SSA at Kassala Al-Saudi Maternity Hospital. Methods: A prospective, observational hospital-based study was conducted from July to December 2025, including 120 obstetric patients aged 18–40 years (ASA II). Total coverage sampling was used. Patients received either CSA with 12.5 mg hyperbaric bupivacaine at L3–L5 or SSA with 8 mg hyperbaric bupivacaine at T10–T11. Hemodynamic parameters were recorded at baseline and every three minutes intraoperatively. Incidence, severity, timing, and frequency of hypotension, along with vasopressor requirements, were compared using SPSS version 26. Statistical significance was set at p < 0.05. Results: CSA resulted in a higher incidence of hypotension, with more moderate and severe cases compared to SSA (p = 0.001). Lowest SBP and DBP values were significantly lower in CSA (p = 0.004 and p = 0.002). Hypotension occurred earlier and more frequently in CSA (p = 0.000, p = 0.013). Vasopressor use and total ephedrine dose were significantly higher in CSA (p = 0.000, p = 0.034). Conclusion: SSA demonstrated superior hemodynamic stability with fewer and less severe hypotensive episodes and reduced vasopressor requirements. SSA may offer a safer alternative to CSA in obstetric anesthesia when performed by trained anesthetists. Figures Figure 1 Figure 2 INTRODUCTION Spinal anesthesia is widely accepted as the preferred anesthetic technique for cesarean section, particularly in elective procedures, due to its ability to avoid many of the hazards associated with general anesthesia. These include the risks of aspiration, difficult airway management, and neonatal depression caused by systemic anesthetic agents ( 1 ). Its technical simplicity, rapid onset of action, and high levels of maternal satisfaction have contributed to its widespread adoption in obstetric practice worldwide, including in low-resource healthcare settings. Despite these advantages, spinal anesthesia is associated with important physiological effects, the most significant of which is maternal hypotension. This complication results primarily from preganglionic sympathetic blockade, leading to a reduction in systemic vascular resistance. The resulting sympatholysis causes peripheral vasodilation, venous pooling, reduced venous return, and a subsequent decline in cardiac output. Even modest reductions in systolic blood pressure can impair uteroplacental perfusion and fetal oxygen delivery, increasing the risk of fetal acidosis, low Apgar scores, and maternal symptoms such as nausea, vomiting, dizziness, and altered consciousness ( 1 , 2 ). Hypotension following spinal anesthesia has been a major focus of obstetric anesthesia research for more than five decades ( 3 ). Its reported incidence varies markedly, ranging from 7.4% to 74.1% ( 1 , 4 ), reflecting differences in patient populations, anesthetic techniques, fluid and vasopressor protocols, and, importantly, the definition of hypotension employed. This wide variation highlights the importance of context-specific data, particularly in low- and middle-income countries where patient characteristics, clinical practices, and resource availability differ from those in high-income settings. In Sudan, spinal anesthesia is the most commonly used technique for cesarean delivery due to its safety profile, feasibility, and suitability for high-volume maternity units. However, perioperative hemodynamic instability remains a significant challenge, especially in centers such as Kassala Al-Saudi Maternity Hospital, where emergency cesarean sections represent a large proportion of the workload. Despite this, local data examining the incidence, severity, and management of spinal-induced hypotension are scarce, and comparative evidence evaluating different spinal techniques—such as conventional spinal anesthesia (CSA) and segmental spinal anesthesia (SSA)—is virtually absent from Sudanese literature. The accurate definition of hypotension is critical when estimating its incidence following spinal anesthesia in obstetric patients. Variability in definitions across studies has led to substantial differences in reported rates and treatment thresholds. Klöhr et al. identified 15 different definitions of hypotension across 63 studies published between 1999 and 2009 that examined spinal or combined spinal–epidural anesthesia for cesarean section ( 4 ). Although all studies relied on systolic arterial pressure measured at the arm, patient positioning and threshold values varied widely, with some studies differentiating between mild and severe hypotension while others used a single cutoff value. The most commonly adopted definitions include a reduction in systolic arterial pressure to 80% of baseline measured before anesthesia, or a composite definition based on either an absolute systolic pressure of 100 mmHg or a decrease to 80% of baseline ( 4 ). A survey conducted in the United Kingdom in 1999 found that most consultant obstetric anesthetists defined hypotension as a systolic pressure of either 100 mmHg or 90 mmHg ( 5 ). Applying these different definitions to the same population of women undergoing elective cesarean section results in a dramatic variation in reported hypotension rates, ranging from 7.4% to 74.1% ( 1 , 4 , 5 ). Clinical evidence suggests that maintaining systolic arterial pressure close to baseline is associated with improved maternal outcomes. Ngan Kee et al. demonstrated that tighter blood pressure control significantly reduced the incidence of nausea and vomiting compared with allowing systolic pressure to fall to 90% or 80% of baseline ( 6 ). Based on such findings, the 2018 consensus guidelines recommend maintaining systolic arterial pressure at or above 90% of baseline and avoiding reductions to 80% following spinal anesthesia ( 7 ). The pathophysiology of spinal-induced hypotension in pregnancy is multifactorial, with rapid onset of sympatholysis playing a central role. Pregnant women exhibit increased sensitivity of nerve fibers to local anesthetics, resulting in a more rapid and extensive sympathetic block than in non-pregnant patients ( 8 , 9 ). The degree of hypotension is closely related to the cranial spread of the local anesthetic within the subarachnoid space, which is difficult to predict and often extends several dermatomes above the sensory block level ( 10 ). This enhanced drug sensitivity, combined with aortocaval compression by the gravid uterus, explains the higher incidence and severity of hypotension observed in obstetric patients ( 8 – 11 ). Pregnancy is also characterized by a physiologically elevated sympathetic tone relative to parasympathetic activity ( 9 , 12 ). When spinal-induced sympatholysis occurs, the sudden withdrawal of sympathetic tone results in pronounced peripheral vasodilation, reduced venous return, and diminished cardiac preload. These changes may manifest clinically as bradycardia, nausea, vomiting, and a significant decrease in cardiac output. Aortocaval compression further exacerbates the reduction in venous return and intensifies hypotension ( 11 , 12 ). Higher levels of sympathetic blockade impair baroreceptor-mediated compensatory mechanisms and increase susceptibility to cardioinhibitory reflexes, such as the Bezold–Jarisch reflex, which can progress to severe bradycardia, cardiac arrest, or death if not promptly treated ( 11 , 13 ). Nausea and vomiting are particularly common during spinal anesthesia for cesarean section and are largely attributable to acute hypotension. Reduced cerebral perfusion may cause transient brainstem ischemia, leading to activation of the vomiting centers ( 14 ). Studies using near-infrared spectroscopy have shown that hypotension is associated with transient cerebral hypoxia, reduced cerebral blood volume, and decreased oxygen saturation ( 15 ). Administration of supplemental oxygen has been shown to reduce the frequency of nausea and may mitigate these cerebral effects ( 16 , 17 ). Severe or prolonged hypotension may result in vertigo, altered consciousness, or syncope, although these symptoms are uncommon when hypotension is recognized and treated promptly. Spinal anesthesia also decreases splanchnic blood flow by approximately 20%, with more pronounced reductions occurring during systemic hypotension ( 18 ). Splanchnic hypoperfusion stimulates the release of emetogenic mediators such as serotonin, further contributing to nausea and vomiting ( 14 ). Although human data on fetal effects are limited, animal studies suggest that sustained reductions in uteroplacental blood flow exceeding 60% can lead to fetal bradycardia and acidaemia ( 19 ). Clinically, neonates born to mothers who experience spinal-induced hypotension have been shown to be more acidotic ( 20 ). The duration of hypotension appears critical, as episodes lasting longer than two minutes are associated with biochemical markers of ischemia–reperfusion injury in umbilical venous blood ( 21 ). Short-lived blood pressure reductions, even of 30% or more, do not appear to adversely affect Apgar scores or immediate neonatal outcomes ( 22 ). However, hypotension persisting for more than four minutes has been linked to early neurobehavioral changes in neonates ( 20 , 23 ). The choice of vasopressor used to manage hypotension is also important for neonatal outcomes. Clinical studies consistently demonstrate that phenylephrine is associated with more favorable neonatal acid–base status compared with ephedrine, making it the vasopressor of choice in modern obstetric anesthesia practice ( 24 , 25 ). Given the risks posed by hypotension to both mother and fetus, extensive research has focused on preventive and therapeutic strategies. Early approaches emphasized fluid loading, particularly crystalloid or colloid preloading, to expand intravascular volume before sympathectomy ( 26 , 27 ). However, crystalloid preloading has largely proven ineffective due to rapid redistribution out of the vascular compartment. This led to the adoption of crystalloid coloading at the time of intrathecal injection, which offers modest benefit but does not reliably prevent hypotension ( 28 ). Colloid solutions have shown greater efficacy in reducing hypotension but carry a small risk of anaphylaxis ( 29 ). Another strategy involves reducing the intrathecal dose of local anesthetic. Studies have shown that cesarean delivery can be performed using as little as 5–7 mg of bupivacaine, resulting in less sympathetic blockade and reduced hypotension ( 30 ). However, very low doses may compromise block reliability and duration and are more suitable for combined spinal–epidural techniques ( 30 ). Mechanical interventions, such as lower-limb compression and modest Trendelenburg positioning, have demonstrated some benefit by maintaining venous return ( 31 , 32 ). Despite these measures, vasopressors remain central to the management of spinal-induced hypotension. Dopamine was used historically, followed by ephedrine, and more recently phenylephrine and norepinephrine ( 7 , 8 , 33 ). Although both ephedrine and phenylephrine effectively restore blood pressure, phenylephrine is associated with lower rates of fetal acidosis and maternal nausea, making it the preferred agent ( 34 , 35 ). Current guidelines recommend combining crystalloid coloading with early initiation of a phenylephrine infusion, titrated to maintain systolic arterial pressure at or above 90% of baseline ( 7 , 36 ). Although effective, phenylephrine may cause bradycardia, prompting interest in norepinephrine as an alternative, though its use remains investigational ( 37 , 38 ). Recent studies have explored ondansetron as a prophylactic agent against spinal-induced hypotension and bradycardia through blockade of 5-HT3 receptors and interruption of the Bezold–Jarisch reflex ( 13 , 39 ). A meta-analysis reported significant reductions in hypotension and bradycardia with pre-spinal ondansetron administration ( 40 ). However, conflicting evidence and study heterogeneity limit its routine recommendation ( 41 ). Comparative studies have demonstrated the potential advantages of SSA over CSA. Desai et al. reported significantly lower hypotension rates, reduced vasopressor use, faster sensory onset, shorter block duration, and improved motor recovery with SSA in preeclamptic parturients ( 42 ). Jain et al. similarly showed that thoracic spinal anesthesia provided superior hemodynamic stability, reduced vasopressor requirements, shorter block durations, fewer adverse effects, and higher maternal satisfaction without compromising neonatal outcomes ( 43 ). Large clinical series and audits by Imbelloni et al. further support the safety and efficacy of thoracic SSA. These studies demonstrated low rates of hypotension and transient paresthesia, with no permanent neurological complications across thousands of patients, reinforcing thoracic SSA as a viable and safe neuraxial technique when performed by experienced practitioners using low-dose bupivacaine ( 44 , 45 ). The main objective of this study is t o compare the incidence of hypotension in obstetric patients receiving CSA versus SSA. Also it's aimed o determine the frequency and severity of hypotension in obstetric patients undergoing and to determine the frequency and severity of hypotension in obstetric patients undergoing C/S under SSA. MATERIALS AND METHODS Study Area: The study was conducted at Kassala Al-Saudi Hospital in Eastern Sudan. It was a tertiary-level facility providing specialized obstetric and gynecological services. The hospital was equipped with outpatient clinics, operating theaters for both elective and emergency cesarean deliveries, inpatient wards, and a post-anesthesia care unit. It also had facilities for routine monitoring and management of surgical and anesthetic cases. Study Duration: The study was carried out from July 2025 to December 2025. Study Design: An observational, cross-sectional, prospective hospital-based study design was used. Study Population: The study population consisted of obstetric patients undergoing C/S under spinal anesthesia. Inclusion Criteria : Pregnant women undergoing cesarean section under spinal anesthesia. ASA II. Age 18–40 years. Exclusion Criteria: Patients with pre-existing hypotension or cardiovascular disease. Patients with severe preeclampsia or eclampsia. Sampling: Sample Size : Total coverage sampling was used, including all eligible cases during the 3-month study period. An estimated 100–150 patients were expected to be included. Data Collection Tools: A structured data collection sheet was used to record patient demographics, type of spinal anesthesia, blood pressure readings, vasopressor use, and maternal/fetal outcomes. Study Variables: Independent Variables: • Type of spinal anesthesia (CSA vs. SSA) • Age Dependent Variables: Incidence and severity of hypotension • Vasopressor dose Materials and Methods: Patients were prepared in the preoperative waiting area, where two wide-bore IV cannulas were inserted and 500–1000 mL of normal saline was infused. Consent was obtained. In the operating room, standard monitoring—noninvasive blood pressure, pulse oximetry, and ECG—was applied, and baseline vital signs were recorded. CSA (Group C) was administered in the sitting position at the L3–L4 or L4–L5 interspace using a 25-gauge Quincke spinal needle. A dose of 12.5 mg of 0.5% hyperbaric bupivacaine was given. After injection, patients were positioned supine with left tilt, and sensory level was assessed bilaterally using a cold alcohol swab. Hemodynamic parameters were recorded every 3 minutes until the end of surgery, and total vasopressor use was calculated. SSA (Group S) was administered in the sitting position under aseptic conditions at the T10–T11 interspace using a 25-gauge Quincke needle. A dose of 8 mg of 0.5% hyperbaric bupivacaine was given. Patients were then placed supine with left tilt, the sensory level was assessed bilaterally, and hemodynamic parameters were recorded every 3 minutes until the end of the operation. Total vasopressor doses were documented. Analysis and Data Processing: Data were analyzed using SPSS version 26. Descriptive statistics summarized demographic and clinical data. Chi-square tests and t-tests compared outcomes between CSA and SSA groups. A p-value < 0.05 was considered statistically significant. Ethical Considerations: Approval was obtained from Sudanese Medical Specialization Board (Anesthesia Council). Approval was obtained from Sudanese Medical Specialization Board (Research Unit). Permission was obtained from the Maternity Teaching Hospital. Data were anonymized to ensure confidentiality. RESULTS Maternal Demographic Characteristics The mean age of participants was comparable between the two groups, with CSA showing a mean age of 27.85 ± 6.12 years and SSA showing 28.53 ± 6.37 years (p=0.360). Gestational age distribution did not differ significantly between the groups (p=0.133). Both groups included patients across gestational ages 28–42 weeks, with the largest proportion in the 37th and 38th weeks in both CSA and SSA groups. Table 1: Maternal Demographic Characteristics by Type of Spinal Anesthesia (N = 120) Variable Category CSA SSA p- value Age (years) Mean ± SD 27.85 ± 6.12 28.53 ± 6.37 0.550 Gestational Age (weeks) 28 0 (0.0%) 1 (0.8%) 0.133 34 3 (2.5%) 1 (0.8%) 35 1 (0.8%) 3 (2.5%) 36 8 (6.7%) 1 (0.8%) 37 15 (12.5%) 18 (15.0%) 38 21 (17.5%) 27 (22.5%) 39 9 (7.5%) 4 (3.3%) 40 1 (0.8%) 3 (2.5%) 41 2 (1.7%) 1 (0.8%) 42 0 (0.0%) 1 (0.8%) Obstetric Characteristics Gravida distribution showed no significant difference between CSA and SSA groups (p=0.550). Patients ranged from gravida 0 to 52 in both groups. Parity also showed no statistically significant variation (p=0.070), with the majority of patients falling within parity 0–3 in both anesthesia types. Clinical Characteristics There was a significant association between cesarean type and the choice of spinal anesthesia (p=0.000). Elective procedures were predominantly performed under SSA, while emergency procedures were more common under CSA. ASA class distribution showed no significant difference between groups (p=0.729), with most patients classified as ASA II. Table 2: Clinical Characteristics by Type of Spinal Anesthesia (N = 120) Variable Category CSA SSA p- value Cesarean Type Elective 34 (28.3%) 57 (47.5%) 0.000* Emergency 26 (21.7%) 3 (2.5%) ASA Class II 55 (45.8%) 56 (46.7%) 0.729 III 5 (4.2%) 4 (3.3%) Anesthesia-Related Characteristics The level of block achieved differed significantly between the two techniques (p=0.000). T4 block occurred only in CSA, while higher thoracic block levels (T5– T6) were more frequent in SSA. Preloading fluid administration differed slightly between groups, with a statistically significant difference (p=0.042). Baseline Hemodynamic Parameters Baseline systolic blood pressure, diastolic blood pressure, and heart rate were comparable between the CSA and SSA groups (p=0.219, p=0.289, and p=0.699 respectively). No significant hemodynamic differences were observed before spinal anesthesia. Post-Spinal Hemodynamic Changes Post-spinal anesthesia lowest SBP and DBP values were significantly lower in the CSA group compared to SSA (p=0.004 and p=0.002). Corresponding heart rates following hypotension episodes did not differ significantly between the groups (p=0.065). Hypotension Characteristics Severity of hypotension differed significantly between CSA and SSA groups (p=0.001). Mild hypotension was more frequent in SSA, while moderate and severe hypotension occurred more often in CSA. Time to first hypotensive episode also varied significantly (p=0.000), with earlier onset in CSA. Frequency of hypotensive episodes showed a significant difference as well (p=0.013), with repeated episodes more common in CSA and absence of hypotension seen more frequently in SSA. Table 3: Hypotension Characteristics by Type of Spinal Anesthesia (N = 120) Variable Category CSA SSA p- value Severity of Hypotension Mild 21 (17.5%) 41 (34.2%) 0.001 Moderate 28 (23.3%) 15 (12.5%) Severe 11 (9.2%) 4 (3.3%) Time to First Hypotensive Episode 10 min 8 (6.7%) 37 (30.8%) Frequency of Hypotensive Episodes 1 episode 29 (24.2%) 23 (19.2%) 0.013 2–3 episodes 13 (10.8%) 5 (4.2%) > 3 episodes 4 (3.3%) 2 (1.7%) None 14 (11.7%) 30 (25.0%) Vasopressor Use and Fluid Management Vasopressor use showed a significant association with anesthesia type (p=0.000). Ephedrine administration was more frequent in CSA, whereas SSA showed more cases requiring no vasopressor. Additional fluid bolus administration was also significantly different (p=0.003), with CSA requiring more fluid interventions. Total Ephedrine Dose Among patients receiving ephedrine, dose distribution differed significantly between groups (p=0.034). Higher doses (≥18 mg) were more common in CSA, whereas SSA showed a greater proportion receiving lower doses (6–12 mg). DISCUSSION This study evaluated conventional spinal anesthesia (CSA) versus segmental spinal anesthesia (SSA) for cesarean section at Kassala Al-Saudi Maternity Hospital, with particular emphasis on the incidence, timing, severity, and management of maternal hypotension. The results clearly demonstrated that SSA was associated with greater hemodynamic stability, fewer and less severe hypotensive episodes, and reduced vasopressor requirements compared with CSA, despite comparable baseline maternal characteristics between the two groups. Maternal demographic and obstetric variables, including age, gestational age, gravida, and parity, were similar in both groups (Table 1 ). Baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were also comparable, indicating that observed differences in post-spinal hemodynamics were primarily attributable to the anesthetic technique rather than patient-related factors. In addition, ASA physical status was similar across groups, with the majority of participants classified as ASA II. A higher proportion of elective cesarean sections was noted in the SSA group, while emergency procedures were more frequent in the CSA group (Table 2 ). However, since baseline hemodynamic parameters did not differ significantly, surgical urgency was unlikely to have influenced the post-spinal hemodynamic outcomes. Marked differences emerged following spinal anesthesia. Patients in the CSA group experienced significantly lower nadir SBP and DBP values compared with those receiving SSA (Fig. 1 ), reflecting deeper hypotensive episodes. Hypotension also occurred earlier under CSA, with a greater proportion of women developing hypotension within the first 5–10 minutes. In contrast, SSA was associated with delayed onset of hypotension, and a significantly larger proportion of patients did not develop hypotension at all. Patterns of hypotension severity further supported these findings. Mild hypotension predominated in the SSA group, whereas moderate and severe hypotension were more frequent under CSA (Table 3 ). Recurrent hypotensive episodes, including two to three or more than three events, were also more common in the CSA group. Collectively, these findings suggest that SSA produces a more controlled and limited sympathetic blockade, thereby reducing vasodilation and venous pooling. Management outcomes were consistent with the improved hemodynamic profile observed with SSA. Ephedrine was required more frequently and in higher cumulative doses in the CSA group, and additional fluid boluses were also more commonly administered. Conversely, a greater proportion of patients in the SSA group required no vasopressor support (Fig. 2 ), and when vasopressors were needed, lower doses were sufficient. This is particularly important in Sudanese healthcare settings, where access to vasopressors, intravenous fluids, and advanced monitoring may be limited. The present findings are in strong agreement with previously published studies. Desai et al. reported significantly lower rates of hypotension with segmental spinal anesthesia compared with conventional spinal anesthesia in preeclamptic parturients (14.29% vs. 37.14%) ( 42 ). Their study also documented reduced vasopressor requirements, more rapid achievement of the target sensory level, and shorter sensory and motor block durations, all of which parallel the current results. Similarly, Jain et al. found that thoracic spinal anesthesia resulted in significantly lower hypotension rates compared with lumbar spinal anesthesia (11.68% vs. 26.31%, p = 0.038), along with reduced ephedrine consumption ( 43 ). The shorter block duration reported in their study is consistent with the low-dose, segmental approach employed in the present work, which achieved adequate anesthesia with minimal hemodynamic compromise. Additional evidence from larger thoracic SSA series further supports these observations. Imbelloni reported a hypotension incidence of only 12.5% in a large cohort undergoing low-dose thoracic spinal anesthesia, with no neurological complications ( 44 ). Likewise, a retrospective audit of 1,406 patients documented hypotension in 13.2% of cases, again without permanent neurological sequelae ( 45 ). These findings reinforce the physiological advantage of limiting sympathetic blockade to the dermatomes required for obstetric surgery. Physiologically, SSA likely limits the cephalad spread of local anesthetic and reduces the extent of sympathetic blockade compared with CSA. By selectively anesthetizing the T10–T11 dermatomes, SSA preserves partial sympathetic tone, maintaining vascular resistance and venous return. This attenuates the abrupt reductions in preload and cardiac output that typically underlie spinal-induced hypotension in pregnant patients ( 8 – 12 ). Within the Sudanese context, these results are particularly relevant. High-volume maternity hospitals often face challenges related to staffing, monitoring capacity, and inconsistent availability of vasopressors. An anesthetic technique that intrinsically reduces hypotension and minimizes the need for pharmacologic intervention may enhance maternal safety and operational efficiency. Nevertheless, successful implementation of SSA requires appropriate training, familiarity with thoracic spinal anatomy, and strict adherence to dosing protocols. CONCLUSION This study found that SSA provided better hemodynamic stability than CSA in obstetric patients undergoing C/S. CSA was associated with earlier, more frequent, and more severe hypotension, as well as higher vasopressor requirements. SSA resulted in fewer and milder episodes without compromising anesthetic effectiveness. Overall, SSA appears to be a safe and advantageous alternative to CSA for reducing maternal hypotension during C/S. RECOMMENDATIONS Adopt SSA as a preferred option for C/S, particularly in elective cases, due to its lower incidence and severity of hypotension and reduced vasopressor requirements. Provide structured training programs for anesthesia providers on thoracic (T10–T11) segmental spinal techniques, emphasizing anatomical safety and low- dose protocols. Standardize monitoring protocols for spinal anesthesia in maternity units, ensuring frequent BP recording (every 2–3 minutes) during the first critical 10 minutes after spinal injection. Develop local guidelines recommending optimal dosing strategies , preloading practices, and vasopressor management for both CSA and SSA. Ensure availability of vasopressors, especially phenylephrine and ephedrine , in all operating theaters to manage hypotension promptly. LIMITATIONS This study has a few limitations. It was conducted in a single hospital, which may limit how widely the results can be applied. The sample size, while sufficient for hemodynamic comparison, may not capture uncommon complications. In addition, SSA requires greater technical skill, and variations in anesthetist experience may have influenced outcomes. Abbreviations Conventional spinal anesthesia (CSA) Segmental spinal anesthesia (SSA) Baseline systolic blood pressure (SBP) diastolic blood pressure (DBP) and heart rate (HR) Declarations Competent of interest: All authors declare no competent of interest Funding : This manuscript received no funding Patient consent: Verbal consent have been taken from the responders who participated in this study The Peer review and Provenance Statement All authors participate in peer review this manuscript, and there is provenance Ethical approval declaration: Ethical approval has been obtained ,Approval was obtained from Sudanese Medical Specialization Board (Anesthesia Council). Consent to participate declaration: All participants are given consent to participate in this work and consent for publication has also be obtained Consent for publications: Consent of publication has been obtained from the participants Authors contribution: Mohanned Author contribution: Mohaned and abdelgadir worked in the data collection and data analysis, weam, Asim and Mahgoub worked in the scientific writing, Ayoub worked in the draft writing and paraphrasing References The New York School of Regional Anesthesia (NYSORA). Spinal anesthesia [Internet]. New York; [cited 2019 Feb 24]. Available from: https://www.nysora.com/techniques/neuraxial-and-perineuraxial- techniques/spinal-anesthesia/ Corke BC, Datta S, Ostheimer GW, Weiss JB, Alper MH. Spinal anaesthesia for caesarean section. The influence of hypotension on neonatal outcome. Anaesthesia. 1982;37:658–62. Kennedy RL, Friedman DL, Katcka DM, Selmants S, Smith RN. Hypotension during obstetrical anesthesia. 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Curr Opin Anaesthesiol. 2008;21:259–62. van Bogaert LJ. Prevention of post-spinal hypotension at elective cesarean section by wrapping of the lower limbs. Int J Gynaecol Obstet. 1998;61:233–8. Sinclair CJ, Scott DB, Edstrom HH. Effect of the Trendelenberg position on spinal anaesthesia with hyperbaric bupivacaine. Br J Anaesth. 1982;54(5):497–500. Ngan Kee WD, Khaw KS, Lee BB, Lau TK, Gin T. A dose response study of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg. 2000;90:1390–5. Habib AS. A review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under spinal anesthesia. Anesth Analg. 2012;114:377–90. Thomas DG, Robson SC, Redfern N, Hughes D, Boys RJ. Randomized trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinal anaesthesia for caesarean section. Br J Anaesth. 1996;76:61–5. Ngan Kee WD, Khaw KS, Ng FF. Prevention of hypotension during spinal anesthesia for cesarean delivery: An effective technique using combination phenylephrine infusion and crystalloid cohydration. Anesthesiology. 2005;103(4):744–50. Ngan Kee WD, Lee SWY, Ng FF, Tan PE, Khaw KS. Randomized double- blinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery. Anesthesiology. 2015;122:736–45. Wang X, Shen X, Liu S, Yang J, Xu S. The efficacy and safety of norepinephrine and its feasibility as a replacement for phenylephrine to manage maternal hypotension during elective cesarean delivery under spinal anesthesia. Biomed Res Int. 2018;2018:1869189. Sahoo T, SenDasgupta C, Goswami A, Hazra A. Reduction in spinal-induced hypotension with ondansetron in parturients undergoing caesarean section: a double-blind randomised, placebo-controlled study. Int J Obstet Anesth. 2012;21(1):24–8. Tubog TD, Kane TD, Pugh MA. Effects of ondansetron on attenuating spinal anesthesia-induced hypotension and bradycardia in obstetric and nonobstetric subjects: a systematic review and meta-analysis. AANA J. 2017;85:113–22. Oofuvong M, Kunapaisal T, Karnjanawanichkul O, Dilokrattanaphijit N, Leeratiwong J. Minimal effective weight-based dosing of ondansetron to reduce hypotension in cesarean section under spinal anesthesia. BMC Anesthesiol. 2018;18(1):105–9. Desai DJ, Shah NK, Kalaimani A. Comparison of segmental versus conventional spinal anaesthesia in preeclamptic parturient undergoing caesarean section: a randomised controlled study. J Clin Diagn Res. 2025;19(1):UC01–7. 10.7860/JCDR/2025/77572.21902 . Jain A, Pandey S, Suhail F, Agarwal S, Jain D, Thakur C. Comparison of Segmental Thoracic and Lumbar Subarachnoid Block in Preeclamptic Patients Undergoing Cesarean Section: An Open-Label Randomized Trial. Cureus. 2025;17(8):e89190. 10.7759/cureus.89190 . PMID: 40895676; PMCID: PMC12398689. Imbelloni LE, Sakamoto JW, Viana EP, Araujo AA, Pöttker D, Pistarino MA. Segmental spinal anesthesia: a systematic review. J Anesth Clin Res. 2020;11:953. 10.35248/2155–6148.20.11.953 . Imbelloni LE, Fornasari M, Sant’Anna R, Morais Filho GB. Thoracic spinal anesthesia is safe and without neurological sequelae: study with 1,406 patients. Int J Anesthetic Anesthesiol. 2022;9:148. 10.23937/2377–4630/1410148 . Additional Declarations No competing interests reported. Supplementary Files APPENDIX.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 11 May, 2026 Reviews received at journal 15 Apr, 2026 Reviews received at journal 13 Apr, 2026 Reviewers agreed at journal 13 Apr, 2026 Reviews received at journal 10 Apr, 2026 Reviewers agreed at journal 10 Apr, 2026 Reviews received at journal 08 Apr, 2026 Reviewers agreed at journal 07 Apr, 2026 Reviewers agreed at journal 05 Apr, 2026 Reviewers invited by journal 03 Apr, 2026 Editor invited by journal 12 Mar, 2026 Editor assigned by journal 05 Jan, 2026 Submission checks completed at journal 01 Jan, 2026 First submitted to journal 01 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8457290","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":619859707,"identity":"b3270079-0dcd-4812-a0d7-2384ad3c362a","order_by":0,"name":"Mohaned Abdelrhman Mohamedahmed Halawi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYBACgwPMDUBSQk6e4fAxsAgbO0EtjCAtFsaGjcfSGBgSgFqYidLCUJHYcPiMGVgLA0Etxw82fuYpkGBsbDvz7cHHH9vk+ZgZGD98zMGtxf5MYrM0j4EEMzvP2e2GMxJuG7YxMzBLztyGz2GJDdI5BhJsjDPObpPmSbjNCNTCxsyLT8v5h82/gVp4GO6/eQbSYk9Yy43ENpAtEgwHzrCBtCQSoeVhm/UfAwkDw4ZjZpIz0m4ntzEzNuP3y/nkwzdn/Kmrn89w+JnEB5vbtvPbmw9++IhHCzYAjqlRMApGwSgYBZQAAFx4VIV2Ls3sAAAAAElFTkSuQmCC","orcid":"","institution":"Almubarak specialized Hospital","correspondingAuthor":true,"prefix":"","firstName":"Mohaned","middleName":"Abdelrhman Mohamedahmed","lastName":"Halawi","suffix":""},{"id":619859708,"identity":"4c15d98f-55ac-4ff8-b291-6885fc005b55","order_by":1,"name":"Abdelgadir Mohammed Abdelfatah dafaalla","email":"","orcid":"","institution":"Kassala-Alsaudi Hospital","correspondingAuthor":false,"prefix":"","firstName":"Abdelgadir","middleName":"Mohammed Abdelfatah","lastName":"dafaalla","suffix":""},{"id":619859709,"identity":"5c02240c-b295-4108-ab9a-4faf94296fc6","order_by":2,"name":"Weam Mohamed Elhadi Bashir Eltayeb, Elhadi Bashir Eltayeb","email":"","orcid":"","institution":"Arrawdah General hospital","correspondingAuthor":false,"prefix":"","firstName":"Elhadi","middleName":"Bashir Eltayeb Weam Mohamed Elhadi Bashir","lastName":"Eltayeb","suffix":""},{"id":619859713,"identity":"4e401a88-4473-49dd-878e-582c492fbbbe","order_by":3,"name":"Asim shamseldein mohamed Ahmed","email":"","orcid":"","institution":"Almubarak specialized Hospital","correspondingAuthor":false,"prefix":"","firstName":"Asim","middleName":"shamseldein mohamed","lastName":"Ahmed","suffix":""},{"id":619859715,"identity":"e18b7b20-12a8-4339-bfcc-de2c9a0758c4","order_by":4,"name":"Mahgoub Adam admin oshaick","email":"","orcid":"","institution":"sudi maternity hospital","correspondingAuthor":false,"prefix":"","firstName":"Mahgoub","middleName":"Adam admin","lastName":"oshaick","suffix":""},{"id":619859718,"identity":"233e030d-a2e3-4592-afba-55073f868379","order_by":5,"name":"AYOUB ABDUALRASHEED MOHAMMEDOTHMAN KHALEEL.","email":"","orcid":"","institution":"Almubarak specialized Hospital","correspondingAuthor":false,"prefix":"","firstName":"AYOUB","middleName":"ABDUALRASHEED MOHAMMEDOTHMAN","lastName":"KHALEEL.","suffix":""}],"badges":[],"createdAt":"2025-12-26 19:08:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8457290/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8457290/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106544785,"identity":"4af0c1ac-0517-4a65-8ea3-7e9a673a62c4","added_by":"auto","created_at":"2026-04-09 16:42:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":82963,"visible":true,"origin":"","legend":"\u003cp\u003eBaseline Hemodynamic Parameters by Type of Spinal Anesthesia\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8457290/v1/ed83a09fdfc2275e650c0841.png"},{"id":106725840,"identity":"6a40d662-fbc4-468d-84c0-8d344a5868ec","added_by":"auto","created_at":"2026-04-12 18:34:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30082,"visible":true,"origin":"","legend":"\u003cp\u003eVasopressor Use by Type of Spinal Anesthesia\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8457290/v1/61901afa959d65136a2fff8f.png"},{"id":107704808,"identity":"e039d203-58b9-4433-b566-6a9801f22a32","added_by":"auto","created_at":"2026-04-24 08:59:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":425704,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8457290/v1/1c347205-4ded-41ae-aa3b-b48ca080d433.pdf"},{"id":106544784,"identity":"83cee1b0-200d-4823-84e7-be811c0f56aa","added_by":"auto","created_at":"2026-04-09 16:42:22","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":515574,"visible":true,"origin":"","legend":"","description":"","filename":"APPENDIX.docx","url":"https://assets-eu.researchsquare.com/files/rs-8457290/v1/88010b0cdcce45f2df9ecd3f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Incidence of Hypotension in Obstetric Patients Undergoing Cesarean Section: Conventional vs. Segmental Spinal Anesthesia at Kassala Al- Saudi Maternity Hospital (July 2025 – December 2025)-A cross sectional study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eSpinal anesthesia is widely accepted as the preferred anesthetic technique for cesarean section, particularly in elective procedures, due to its ability to avoid many of the hazards associated with general anesthesia. These include the risks of aspiration, difficult airway management, and neonatal depression caused by systemic anesthetic agents (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Its technical simplicity, rapid onset of action, and high levels of maternal satisfaction have contributed to its widespread adoption in obstetric practice worldwide, including in low-resource healthcare settings.\u003c/p\u003e \u003cp\u003eDespite these advantages, spinal anesthesia is associated with important physiological effects, the most significant of which is maternal hypotension. This complication results primarily from preganglionic sympathetic blockade, leading to a reduction in systemic vascular resistance. The resulting sympatholysis causes peripheral vasodilation, venous pooling, reduced venous return, and a subsequent decline in cardiac output. Even modest reductions in systolic blood pressure can impair uteroplacental perfusion and fetal oxygen delivery, increasing the risk of fetal acidosis, low Apgar scores, and maternal symptoms such as nausea, vomiting, dizziness, and altered consciousness (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHypotension following spinal anesthesia has been a major focus of obstetric anesthesia research for more than five decades (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Its reported incidence varies markedly, ranging from 7.4% to 74.1% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), reflecting differences in patient populations, anesthetic techniques, fluid and vasopressor protocols, and, importantly, the definition of hypotension employed. This wide variation highlights the importance of context-specific data, particularly in low- and middle-income countries where patient characteristics, clinical practices, and resource availability differ from those in high-income settings.\u003c/p\u003e \u003cp\u003eIn Sudan, spinal anesthesia is the most commonly used technique for cesarean delivery due to its safety profile, feasibility, and suitability for high-volume maternity units. However, perioperative hemodynamic instability remains a significant challenge, especially in centers such as Kassala Al-Saudi Maternity Hospital, where emergency cesarean sections represent a large proportion of the workload. Despite this, local data examining the incidence, severity, and management of spinal-induced hypotension are scarce, and comparative evidence evaluating different spinal techniques\u0026mdash;such as conventional spinal anesthesia (CSA) and segmental spinal anesthesia (SSA)\u0026mdash;is virtually absent from Sudanese literature.\u003c/p\u003e \u003cp\u003eThe accurate definition of hypotension is critical when estimating its incidence following spinal anesthesia in obstetric patients. Variability in definitions across studies has led to substantial differences in reported rates and treatment thresholds. Kl\u0026ouml;hr et al. identified 15 different definitions of hypotension across 63 studies published between 1999 and 2009 that examined spinal or combined spinal\u0026ndash;epidural anesthesia for cesarean section (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Although all studies relied on systolic arterial pressure measured at the arm, patient positioning and threshold values varied widely, with some studies differentiating between mild and severe hypotension while others used a single cutoff value.\u003c/p\u003e \u003cp\u003eThe most commonly adopted definitions include a reduction in systolic arterial pressure to 80% of baseline measured before anesthesia, or a composite definition based on either an absolute systolic pressure of 100 mmHg or a decrease to 80% of baseline (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). A survey conducted in the United Kingdom in 1999 found that most consultant obstetric anesthetists defined hypotension as a systolic pressure of either 100 mmHg or 90 mmHg (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Applying these different definitions to the same population of women undergoing elective cesarean section results in a dramatic variation in reported hypotension rates, ranging from 7.4% to 74.1% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eClinical evidence suggests that maintaining systolic arterial pressure close to baseline is associated with improved maternal outcomes. Ngan Kee et al. demonstrated that tighter blood pressure control significantly reduced the incidence of nausea and vomiting compared with allowing systolic pressure to fall to 90% or 80% of baseline (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Based on such findings, the 2018 consensus guidelines recommend maintaining systolic arterial pressure at or above 90% of baseline and avoiding reductions to 80% following spinal anesthesia (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe pathophysiology of spinal-induced hypotension in pregnancy is multifactorial, with rapid onset of sympatholysis playing a central role. Pregnant women exhibit increased sensitivity of nerve fibers to local anesthetics, resulting in a more rapid and extensive sympathetic block than in non-pregnant patients (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The degree of hypotension is closely related to the cranial spread of the local anesthetic within the subarachnoid space, which is difficult to predict and often extends several dermatomes above the sensory block level (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). This enhanced drug sensitivity, combined with aortocaval compression by the gravid uterus, explains the higher incidence and severity of hypotension observed in obstetric patients (\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePregnancy is also characterized by a physiologically elevated sympathetic tone relative to parasympathetic activity (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). When spinal-induced sympatholysis occurs, the sudden withdrawal of sympathetic tone results in pronounced peripheral vasodilation, reduced venous return, and diminished cardiac preload. These changes may manifest clinically as bradycardia, nausea, vomiting, and a significant decrease in cardiac output. Aortocaval compression further exacerbates the reduction in venous return and intensifies hypotension (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Higher levels of sympathetic blockade impair baroreceptor-mediated compensatory mechanisms and increase susceptibility to cardioinhibitory reflexes, such as the Bezold\u0026ndash;Jarisch reflex, which can progress to severe bradycardia, cardiac arrest, or death if not promptly treated (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNausea and vomiting are particularly common during spinal anesthesia for cesarean section and are largely attributable to acute hypotension. Reduced cerebral perfusion may cause transient brainstem ischemia, leading to activation of the vomiting centers (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Studies using near-infrared spectroscopy have shown that hypotension is associated with transient cerebral hypoxia, reduced cerebral blood volume, and decreased oxygen saturation (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Administration of supplemental oxygen has been shown to reduce the frequency of nausea and may mitigate these cerebral effects (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Severe or prolonged hypotension may result in vertigo, altered consciousness, or syncope, although these symptoms are uncommon when hypotension is recognized and treated promptly.\u003c/p\u003e \u003cp\u003eSpinal anesthesia also decreases splanchnic blood flow by approximately 20%, with more pronounced reductions occurring during systemic hypotension (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Splanchnic hypoperfusion stimulates the release of emetogenic mediators such as serotonin, further contributing to nausea and vomiting (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Although human data on fetal effects are limited, animal studies suggest that sustained reductions in uteroplacental blood flow exceeding 60% can lead to fetal bradycardia and acidaemia (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Clinically, neonates born to mothers who experience spinal-induced hypotension have been shown to be more acidotic (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The duration of hypotension appears critical, as episodes lasting longer than two minutes are associated with biochemical markers of ischemia\u0026ndash;reperfusion injury in umbilical venous blood (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Short-lived blood pressure reductions, even of 30% or more, do not appear to adversely affect Apgar scores or immediate neonatal outcomes (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). However, hypotension persisting for more than four minutes has been linked to early neurobehavioral changes in neonates (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe choice of vasopressor used to manage hypotension is also important for neonatal outcomes. Clinical studies consistently demonstrate that phenylephrine is associated with more favorable neonatal acid\u0026ndash;base status compared with ephedrine, making it the vasopressor of choice in modern obstetric anesthesia practice (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven the risks posed by hypotension to both mother and fetus, extensive research has focused on preventive and therapeutic strategies. Early approaches emphasized fluid loading, particularly crystalloid or colloid preloading, to expand intravascular volume before sympathectomy (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). However, crystalloid preloading has largely proven ineffective due to rapid redistribution out of the vascular compartment. This led to the adoption of crystalloid coloading at the time of intrathecal injection, which offers modest benefit but does not reliably prevent hypotension (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Colloid solutions have shown greater efficacy in reducing hypotension but carry a small risk of anaphylaxis (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnother strategy involves reducing the intrathecal dose of local anesthetic. Studies have shown that cesarean delivery can be performed using as little as 5\u0026ndash;7 mg of bupivacaine, resulting in less sympathetic blockade and reduced hypotension (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). However, very low doses may compromise block reliability and duration and are more suitable for combined spinal\u0026ndash;epidural techniques (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Mechanical interventions, such as lower-limb compression and modest Trendelenburg positioning, have demonstrated some benefit by maintaining venous return (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite these measures, vasopressors remain central to the management of spinal-induced hypotension. Dopamine was used historically, followed by ephedrine, and more recently phenylephrine and norepinephrine (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Although both ephedrine and phenylephrine effectively restore blood pressure, phenylephrine is associated with lower rates of fetal acidosis and maternal nausea, making it the preferred agent (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Current guidelines recommend combining crystalloid coloading with early initiation of a phenylephrine infusion, titrated to maintain systolic arterial pressure at or above 90% of baseline (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Although effective, phenylephrine may cause bradycardia, prompting interest in norepinephrine as an alternative, though its use remains investigational (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRecent studies have explored ondansetron as a prophylactic agent against spinal-induced hypotension and bradycardia through blockade of 5-HT3 receptors and interruption of the Bezold\u0026ndash;Jarisch reflex (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). A meta-analysis reported significant reductions in hypotension and bradycardia with pre-spinal ondansetron administration (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). However, conflicting evidence and study heterogeneity limit its routine recommendation (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eComparative studies have demonstrated the potential advantages of SSA over CSA. Desai et al. reported significantly lower hypotension rates, reduced vasopressor use, faster sensory onset, shorter block duration, and improved motor recovery with SSA in preeclamptic parturients (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Jain et al. similarly showed that thoracic spinal anesthesia provided superior hemodynamic stability, reduced vasopressor requirements, shorter block durations, fewer adverse effects, and higher maternal satisfaction without compromising neonatal outcomes (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLarge clinical series and audits by Imbelloni et al. further support the safety and efficacy of thoracic SSA. These studies demonstrated low rates of hypotension and transient paresthesia, with no permanent neurological complications across thousands of patients, reinforcing thoracic SSA as a viable and safe neuraxial technique when performed by experienced practitioners using low-dose bupivacaine (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). The main objective of this study is t\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eo compare the incidence of hypotension in obstetric patients receiving CSA versus SSA. Also\u003c/span\u003e it's aimed \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eo determine the frequency and severity of hypotension in obstetric patients undergoing\u003c/span\u003e and to determine \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe frequency and severity of hypotension in obstetric patients undergoing C/S under SSA.\u003c/span\u003e\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Area:\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe study was conducted at Kassala Al-Saudi Hospital in Eastern Sudan. It was a tertiary-level facility providing specialized obstetric and gynecological services. The hospital was equipped with outpatient clinics, operating theaters for both elective and emergency cesarean deliveries, inpatient wards, and a post-anesthesia care unit. It also had facilities for routine monitoring and management of surgical and anesthetic cases.\u003c/span\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Duration:\u003c/h3\u003e\n\u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe study was carried out from July 2025 to December 2025.\u003c/span\u003e \u003c/p\u003e\n\u003ch3\u003eStudy Design:\u003c/h3\u003e\n\u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAn observational, cross-sectional, prospective hospital-based study design was used.\u003c/span\u003e \u003c/p\u003e\n\u003ch3\u003eStudy Population:\u003c/h3\u003e\n\u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe study population consisted of obstetric patients undergoing C/S under spinal anesthesia.\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInclusion Criteria\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ePregnant women undergoing cesarean section under spinal anesthesia.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eASA II.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAge 18\u0026ndash;40 years.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e\n\u003ch3\u003eExclusion Criteria:\u003c/h3\u003e\n\u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ePatients with pre-existing hypotension or cardiovascular disease.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ePatients with severe preeclampsia or eclampsia.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSampling:\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eSample Size\u003c/span\u003e:\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eTotal coverage sampling was used, including all eligible cases during the 3-month study period. An estimated 100\u0026ndash;150 patients were expected to be included.\u003c/span\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection Tools:\u003c/h3\u003e\n\u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eA structured data collection sheet was used to record patient demographics, type of spinal anesthesia, blood pressure readings, vasopressor use, and maternal/fetal outcomes.\u003c/span\u003e \u003c/p\u003e\n\u003ch3\u003eStudy Variables: Independent Variables:\u003c/h3\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e\u0026bull; \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eType of spinal anesthesia (CSA vs. SSA)\u003c/span\u003e\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e\u0026bull; \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAge\u003c/span\u003e\u003c/h2\u003e \u003cdiv id=\"Sec13\" class=\"Section4\"\u003e \u003ch2\u003eDependent Variables:\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eIncidence and severity of hypotension\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e\u0026bull; \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eVasopressor dose\u003c/span\u003e\u003c/h2\u003e \u003c/div\u003e\n\u003ch3\u003eMaterials and Methods:\u003c/h3\u003e\n\u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ePatients were prepared in the preoperative waiting area, where two wide-bore IV cannulas were inserted and 500\u0026ndash;1000 mL of normal saline was infused. Consent was obtained. In the operating room, standard monitoring\u0026mdash;noninvasive blood pressure, pulse oximetry, and ECG\u0026mdash;was applied, and baseline vital signs were recorded.\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eCSA (Group C) was administered in the sitting position at the L3\u0026ndash;L4 or L4\u0026ndash;L5 interspace using a 25-gauge Quincke spinal needle. A dose of 12.5 mg of 0.5% hyperbaric bupivacaine was given. After injection, patients were positioned supine with left tilt, and sensory level was assessed bilaterally using a cold alcohol swab. Hemodynamic parameters were recorded every 3 minutes until the end of surgery, and total vasopressor use was calculated.\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eSSA (Group S) was administered in the sitting position under aseptic conditions at the T10\u0026ndash;T11 interspace using a 25-gauge Quincke needle. A dose of 8 mg of 0.5% hyperbaric bupivacaine was given. Patients were then placed supine with left tilt, the sensory level was assessed bilaterally, and hemodynamic parameters were recorded every 3 minutes until the end of the operation. Total vasopressor doses were documented.\u003c/span\u003e \u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis and Data Processing:\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eData were analyzed using SPSS version 26.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDescriptive statistics summarized demographic and clinical data.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eChi-square tests and t-tests compared outcomes between CSA and SSA groups.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eA p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations:\u003c/h2\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e Approval was obtained from Sudanese Medical Specialization Board (Anesthesia Council).\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e Approval was obtained from Sudanese Medical Specialization Board (Research Unit).\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ePermission was obtained from the Maternity Teaching Hospital.\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eData were anonymized to ensure confidentiality.\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003c/div\u003e "},{"header":"RESULTS","content":"\u003ch2\u003eMaternal Demographic Characteristics\u003c/h2\u003e\n\u003cp\u003eThe mean age of participants was comparable between the two groups, with CSA showing a mean age of 27.85 \u0026plusmn; 6.12 years and SSA showing 28.53 \u0026plusmn; 6.37 years (p=0.360). Gestational age distribution did not differ significantly between the groups (p=0.133). Both groups included patients across gestational ages 28\u0026ndash;42 weeks, with the largest proportion in the 37th and 38th weeks in both CSA and SSA groups.\u003c/p\u003e\n\u003cp\u003eTable 1: Maternal Demographic Characteristics by Type of Spinal Anesthesia (N = 120)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eCSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eSSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003ep- value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e27.85 \u0026plusmn; 6.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e28.53 \u0026plusmn; 6.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.550\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eGestational Age (weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e3 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e3 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e8 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e15 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e18 (15.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e21 (17.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e27 (22.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e9 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e4 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e3 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObstetric Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGravida distribution showed no significant difference between CSA and SSA groups (p=0.550). Patients ranged from gravida 0 to 52 in both groups. Parity also showed no statistically significant variation (p=0.070), with the majority of patients falling within parity 0\u0026ndash;3 in both anesthesia types.\u003c/p\u003e\n\u003ch2\u003eClinical Characteristics\u003c/h2\u003e\n\u003cp\u003eThere was a significant association between cesarean type and the choice of spinal anesthesia (p=0.000). Elective procedures were predominantly performed under SSA, while emergency procedures were more common under CSA. ASA class distribution showed no significant difference between groups (p=0.729), with most patients classified as ASA II.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2: Clinical Characteristics by Type of Spinal Anesthesia (N = 120)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eCSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eSSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003ep- value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eCesarean Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eElective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e34 (28.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e57 (47.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eEmergency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e26 (21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e3 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eASA Class\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e55 (45.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e56 (46.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.729\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e5 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e4 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnesthesia-Related Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe level of block achieved differed significantly between the two techniques (p=0.000). T4 block occurred only in CSA, while higher thoracic block levels (T5\u0026ndash; T6) were more frequent in SSA. Preloading fluid administration differed slightly between groups, with a statistically significant difference (p=0.042).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBaseline Hemodynamic Parameters\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBaseline systolic blood pressure, diastolic blood pressure, and heart rate were comparable between the CSA and SSA groups (p=0.219, p=0.289, and p=0.699 respectively). No significant hemodynamic differences were observed before spinal anesthesia.\u003c/p\u003e\n\u003ch2\u003ePost-Spinal Hemodynamic Changes\u003c/h2\u003e\n\u003cp\u003ePost-spinal anesthesia lowest SBP and DBP values were significantly lower in the CSA group compared to SSA (p=0.004 and p=0.002). Corresponding heart rates following hypotension episodes did not differ significantly between the groups (p=0.065).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypotension Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeverity of hypotension differed significantly between CSA and SSA groups (p=0.001). Mild hypotension was more frequent in SSA, while moderate and severe hypotension occurred more often in CSA. Time to first hypotensive episode also varied significantly (p=0.000), with earlier onset in CSA. Frequency of hypotensive episodes showed a significant difference as well (p=0.013), with repeated episodes more common in CSA and absence of hypotension seen more frequently in SSA.\u003c/p\u003e\n\u003cp\u003eTable 3: Hypotension Characteristics by Type of Spinal Anesthesia (N = 120)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eCSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eSSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003ep- value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eSeverity of Hypotension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e21 (17.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e41 (34.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e28 (23.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e15 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e11 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e4 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eTime to First Hypotensive Episode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026lt; 5 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e26 (21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e14 (11.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e5\u0026ndash;10 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e26 (21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e9 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026gt; 10 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e8 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e37 (30.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eFrequency of Hypotensive Episodes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 episode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e29 (24.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e23 (19.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e2\u0026ndash;3\u003c/p\u003e\n \u003cp\u003eepisodes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e13 (10.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e5 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026gt; 3\u003c/p\u003e\n \u003cp\u003eepisodes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e4 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e2 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e14 (11.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e30 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVasopressor Use and Fluid Management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVasopressor use showed a significant association with anesthesia type (p=0.000). Ephedrine administration was more frequent in CSA, whereas SSA showed more cases requiring no vasopressor. Additional fluid bolus administration was also significantly different (p=0.003), with CSA requiring more fluid interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTotal Ephedrine Dose\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong patients receiving ephedrine, dose distribution differed significantly between groups (p=0.034). Higher doses (\u0026ge;18 mg) were more common in CSA, whereas SSA showed a greater proportion receiving lower doses (6\u0026ndash;12 mg).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study evaluated conventional spinal anesthesia (CSA) versus segmental spinal anesthesia (SSA) for cesarean section at Kassala Al-Saudi Maternity Hospital, with particular emphasis on the incidence, timing, severity, and management of maternal hypotension. The results clearly demonstrated that SSA was associated with greater hemodynamic stability, fewer and less severe hypotensive episodes, and reduced vasopressor requirements compared with CSA, despite comparable baseline maternal characteristics between the two groups.\u003c/p\u003e \u003cp\u003eMaternal demographic and obstetric variables, including age, gestational age, gravida, and parity, were similar in both groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were also comparable, indicating that observed differences in post-spinal hemodynamics were primarily attributable to the anesthetic technique rather than patient-related factors. In addition, ASA physical status was similar across groups, with the majority of participants classified as ASA II.\u003c/p\u003e \u003cp\u003eA higher proportion of elective cesarean sections was noted in the SSA group, while emergency procedures were more frequent in the CSA group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). However, since baseline hemodynamic parameters did not differ significantly, surgical urgency was unlikely to have influenced the post-spinal hemodynamic outcomes.\u003c/p\u003e \u003cp\u003eMarked differences emerged following spinal anesthesia. Patients in the CSA group experienced significantly lower nadir SBP and DBP values compared with those receiving SSA (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), reflecting deeper hypotensive episodes. Hypotension also occurred earlier under CSA, with a greater proportion of women developing hypotension within the first 5\u0026ndash;10 minutes. In contrast, SSA was associated with delayed onset of hypotension, and a significantly larger proportion of patients did not develop hypotension at all.\u003c/p\u003e \u003cp\u003ePatterns of hypotension severity further supported these findings. Mild hypotension predominated in the SSA group, whereas moderate and severe hypotension were more frequent under CSA (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Recurrent hypotensive episodes, including two to three or more than three events, were also more common in the CSA group. Collectively, these findings suggest that SSA produces a more controlled and limited sympathetic blockade, thereby reducing vasodilation and venous pooling.\u003c/p\u003e \u003cp\u003eManagement outcomes were consistent with the improved hemodynamic profile observed with SSA. Ephedrine was required more frequently and in higher cumulative doses in the CSA group, and additional fluid boluses were also more commonly administered. Conversely, a greater proportion of patients in the SSA group required no vasopressor support (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), and when vasopressors were needed, lower doses were sufficient. This is particularly important in Sudanese healthcare settings, where access to vasopressors, intravenous fluids, and advanced monitoring may be limited.\u003c/p\u003e \u003cp\u003eThe present findings are in strong agreement with previously published studies. Desai et al. reported significantly lower rates of hypotension with segmental spinal anesthesia compared with conventional spinal anesthesia in preeclamptic parturients (14.29% vs. 37.14%) (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Their study also documented reduced vasopressor requirements, more rapid achievement of the target sensory level, and shorter sensory and motor block durations, all of which parallel the current results. Similarly, Jain et al. found that thoracic spinal anesthesia resulted in significantly lower hypotension rates compared with lumbar spinal anesthesia (11.68% vs. 26.31%, p\u0026thinsp;=\u0026thinsp;0.038), along with reduced ephedrine consumption (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). The shorter block duration reported in their study is consistent with the low-dose, segmental approach employed in the present work, which achieved adequate anesthesia with minimal hemodynamic compromise.\u003c/p\u003e \u003cp\u003eAdditional evidence from larger thoracic SSA series further supports these observations. Imbelloni reported a hypotension incidence of only 12.5% in a large cohort undergoing low-dose thoracic spinal anesthesia, with no neurological complications (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Likewise, a retrospective audit of 1,406 patients documented hypotension in 13.2% of cases, again without permanent neurological sequelae (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). These findings reinforce the physiological advantage of limiting sympathetic blockade to the dermatomes required for obstetric surgery.\u003c/p\u003e \u003cp\u003ePhysiologically, SSA likely limits the cephalad spread of local anesthetic and reduces the extent of sympathetic blockade compared with CSA. By selectively anesthetizing the T10\u0026ndash;T11 dermatomes, SSA preserves partial sympathetic tone, maintaining vascular resistance and venous return. This attenuates the abrupt reductions in preload and cardiac output that typically underlie spinal-induced hypotension in pregnant patients (\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWithin the Sudanese context, these results are particularly relevant. High-volume maternity hospitals often face challenges related to staffing, monitoring capacity, and inconsistent availability of vasopressors. An anesthetic technique that intrinsically reduces hypotension and minimizes the need for pharmacologic intervention may enhance maternal safety and operational efficiency. Nevertheless, successful implementation of SSA requires appropriate training, familiarity with thoracic spinal anatomy, and strict adherence to dosing protocols.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThis study found that SSA provided better hemodynamic stability than CSA in obstetric patients undergoing C/S. CSA was associated with earlier, more frequent, and more severe hypotension, as well as higher vasopressor requirements. SSA resulted in fewer and milder episodes without compromising anesthetic effectiveness. Overall, SSA appears to be a safe and advantageous alternative to CSA for reducing maternal hypotension during C/S.\u003c/span\u003e \u003c/p\u003e"},{"header":"RECOMMENDATIONS","content":"\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAdopt SSA as a preferred option for C/S, particularly in elective cases, due to its lower incidence and severity of hypotension and reduced vasopressor requirements.\u003c/span\u003e\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eProvide structured training programs for anesthesia providers on thoracic (T10\u0026ndash;T11) segmental spinal techniques, emphasizing anatomical safety and low- dose protocols.\u003c/span\u003e\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eStandardize monitoring protocols for spinal anesthesia in maternity units, ensuring frequent BP recording (every 2\u0026ndash;3 minutes) during the first critical 10 minutes after spinal injection.\u003c/span\u003e\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDevelop local guidelines recommending optimal dosing strategies\u003c/span\u003e,\u0026nbsp;\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003epreloading practices, and vasopressor management for both CSA and SSA.\u003c/span\u003e\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eEnsure availability of vasopressors, especially phenylephrine and ephedrine\u003c/span\u003e,\u0026nbsp;\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ein all operating theaters to manage hypotension promptly.\u003c/span\u003e\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cdiv id=\"Sec30\" class=\"Section2\"\u003e\n \u003ch2\u003eLIMITATIONS\u003c/h2\u003e\n \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThis study has a few limitations. It was conducted in a single hospital, which may limit how widely the results can be applied. The sample size, while sufficient for hemodynamic comparison, may not capture uncommon complications. In addition, SSA requires greater technical skill, and variations in anesthetist experience may have influenced outcomes.\u003c/span\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eConventional spinal anesthesia (CSA)\u003c/p\u003e\n\u003cp\u003eSegmental spinal anesthesia (SSA)\u003c/p\u003e\n\u003cp\u003eBaseline systolic blood pressure (SBP)\u003c/p\u003e\n\u003cp\u003ediastolic blood pressure (DBP)\u003c/p\u003e\n\u003cp\u003eand heart rate (HR)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompetent of interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare no competent of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eThis manuscript received no funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVerbal consent have been taken from the responders who participated in this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Peer review and Provenance Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors participate in peer review this manuscript, and there is provenance\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval declaration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval has been obtained ,Approval was obtained from Sudanese Medical Specialization Board (Anesthesia\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCouncil).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate declaration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants are given consent to participate in this work and consent for publication has also be obtained\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publications:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent of publication has been obtained from the participants\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMohanned\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMohaned and abdelgadir worked in the data collection and data analysis, weam, Asim and Mahgoub worked in the scientific writing, Ayoub worked in the draft writing and paraphrasing\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eThe New York School of Regional Anesthesia (NYSORA). Spinal anesthesia [Internet]. New York; [cited 2019 Feb 24]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nysora.com/techniques/neuraxial-and-perineuraxial- techniques/spinal-anesthesia/\u003c/span\u003e\u003cspan address=\"https://www.nysora.com/techniques/neuraxial-and-perineuraxial- techniques/spinal-anesthesia/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorke BC, Datta S, Ostheimer GW, Weiss JB, Alper MH. Spinal anaesthesia for caesarean section. The influence of hypotension on neonatal outcome. Anaesthesia. 1982;37:658\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKennedy RL, Friedman DL, Katcka DM, Selmants S, Smith RN. Hypotension during obstetrical anesthesia. 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J Anesth. 2016;30:603\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRatra CK, Badola RP, Bhargava KP. A study of factors concerned in emesis during spinal anaesthesia. Br J Anaesth. 1972;44:1208\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHirose N, Kondo Y, Maeda T, Suzuki T, Yoshino A, Katayama Y. Oxygen supplementation is effective in attenuating maternal cerebral blood deoxygenation after spinal anesthesia for cesarean section. Adv Exp Med Biol. 2016;876:471\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCooperman LH. Effects of anaesthetics on the splanchnic circulation. Br J Anaesth. 1972;44:967\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSkillman CA, Plessinger MA, Woods JR, Clark KE. Effect of graded reductions in uteroplacental blood flow on the fetal lamb. Am J Physiol. 1985;249:H1098\u0026ndash;105.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorke BC, Datta S, Ostheimer GW, Weiss JB, Alper MH. Spinal anaesthesia for Caesarean section. The influence of hypotension on neonatal outcome. Anaesthesia. 1982;37:658\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkudaira S, Suzuki S. Influence of spinal hypotension on fetal oxidative status during elective cesarean section in uncomplicated pregnancies. Arch Gynecol Obstet. 2005;271:292\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaayan-Metzger A, Schushan Eisen I, Todris L, Etchin A, Kuint J. Maternal hypotension during elective cesarean section and short-term neonatal outcome. Am J Obstet Gynecol. 2010;202(1):e561\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHollmen AI, Jouppila R, Koivisto M, et al. Neurologic activity of infants following anesthesia for cesarean section. 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Br J Anaesth. 1995;75:531\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark GE, Hauch MA, Curlin F, Datta S, Bader AM. The effects of varying volumes of crystalloid administration before cesarean delivery on maternal hemodynamics and colloid osmotic pressure. Anesth Analg. 1996;83:299\u0026ndash;303.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDyer RA, Farina Z, Joubert IA, et al. Crystalloid preload versus rapid crystalloid administration after induction of spinal anaesthesia (coload) for elective caesarean section. Anaesth Intensive Care. 2004;32(3):351\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDahlgren G, Granath F, Pregner K, Rosblad PG, Wessel H, Irestedt L. Colloid vs. crystalloid preloading to prevent maternal hypotension during spinal anesthesia for elective cesarean section. 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Anesth Analg. 2000;90:1390\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHabib AS. A review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under spinal anesthesia. Anesth Analg. 2012;114:377\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThomas DG, Robson SC, Redfern N, Hughes D, Boys RJ. Randomized trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinal anaesthesia for caesarean section. Br J Anaesth. 1996;76:61\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNgan Kee WD, Khaw KS, Ng FF. Prevention of hypotension during spinal anesthesia for cesarean delivery: An effective technique using combination phenylephrine infusion and crystalloid cohydration. Anesthesiology. 2005;103(4):744\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNgan Kee WD, Lee SWY, Ng FF, Tan PE, Khaw KS. Randomized double- blinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery. Anesthesiology. 2015;122:736\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang X, Shen X, Liu S, Yang J, Xu S. The efficacy and safety of norepinephrine and its feasibility as a replacement for phenylephrine to manage maternal hypotension during elective cesarean delivery under spinal anesthesia. Biomed Res Int. 2018;2018:1869189.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSahoo T, SenDasgupta C, Goswami A, Hazra A. Reduction in spinal-induced hypotension with ondansetron in parturients undergoing caesarean section: a double-blind randomised, placebo-controlled study. Int J Obstet Anesth. 2012;21(1):24\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTubog TD, Kane TD, Pugh MA. Effects of ondansetron on attenuating spinal anesthesia-induced hypotension and bradycardia in obstetric and nonobstetric subjects: a systematic review and meta-analysis. AANA J. 2017;85:113\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOofuvong M, Kunapaisal T, Karnjanawanichkul O, Dilokrattanaphijit N, Leeratiwong J. Minimal effective weight-based dosing of ondansetron to reduce hypotension in cesarean section under spinal anesthesia. BMC Anesthesiol. 2018;18(1):105\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDesai DJ, Shah NK, Kalaimani A. Comparison of segmental versus conventional spinal anaesthesia in preeclamptic parturient undergoing caesarean section: a randomised controlled study. J Clin Diagn Res. 2025;19(1):UC01\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7860/JCDR/2025/77572.21902\u003c/span\u003e\u003cspan address=\"10.7860/JCDR/2025/77572.21902\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJain A, Pandey S, Suhail F, Agarwal S, Jain D, Thakur C. Comparison of Segmental Thoracic and Lumbar Subarachnoid Block in Preeclamptic Patients Undergoing Cesarean Section: An Open-Label Randomized Trial. Cureus. 2025;17(8):e89190. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.89190\u003c/span\u003e\u003cspan address=\"10.7759/cureus.89190\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 40895676; PMCID: PMC12398689.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eImbelloni LE, Sakamoto JW, Viana EP, Araujo AA, P\u0026ouml;ttker D, Pistarino MA. Segmental spinal anesthesia: a systematic review. J Anesth Clin Res. 2020;11:953. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.35248/2155\u0026ndash;6148.20.11.953\u003c/span\u003e\u003cspan address=\"10.35248/2155\u0026ndash;6148.20.11.953\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eImbelloni LE, Fornasari M, Sant\u0026rsquo;Anna R, Morais Filho GB. Thoracic spinal anesthesia is safe and without neurological sequelae: study with 1,406 patients. Int J Anesthetic Anesthesiol. 2022;9:148. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.23937/2377\u0026ndash;4630/1410148\u003c/span\u003e\u003cspan address=\"10.23937/2377\u0026ndash;4630/1410148\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8457290/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8457290/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eHypotension is the most common and significant complication of spinal anesthesia during cesarean section, often resulting in maternal discomfort and reduced uteroplacental perfusion, which may compromise fetal well-being. Conventional spinal anesthesia (CSA) is widely used in Sudan but is associated with high rates of hypotension. Segmental spinal anesthesia (SSA), which targets a more restricted dermatomal block, has been proposed as a technique that may offer improved hemodynamic stability. However, evidence comparing both techniques in Sudanese obstetric practice is limited.\u003c/span\u003e \u003c/p\u003e\u003ch2\u003eObjective:\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eTo compare the incidence and severity of hypotension in obstetric patients undergoing cesarean section under CSA versus SSA at Kassala Al-Saudi Maternity Hospital.\u003c/span\u003e \u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eA prospective, observational hospital-based study was conducted from July to December 2025, including 120 obstetric patients aged 18\u0026ndash;40 years (ASA II). Total coverage sampling was used. Patients received either CSA with 12.5 mg hyperbaric bupivacaine at L3\u0026ndash;L5 or SSA with 8 mg hyperbaric bupivacaine at T10\u0026ndash;T11. Hemodynamic parameters were recorded at baseline and every three minutes intraoperatively. Incidence, severity, timing, and frequency of hypotension, along with vasopressor requirements, were compared using SPSS version 26. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/span\u003e \u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eCSA resulted in a higher incidence of hypotension, with more moderate and severe cases compared to SSA (p\u0026thinsp;=\u0026thinsp;0.001). Lowest SBP and DBP values were significantly lower in CSA (p\u0026thinsp;=\u0026thinsp;0.004 and p\u0026thinsp;=\u0026thinsp;0.002). Hypotension occurred earlier and more frequently in CSA (p\u0026thinsp;=\u0026thinsp;0.000, p\u0026thinsp;=\u0026thinsp;0.013). Vasopressor use and total ephedrine dose were significantly higher in CSA (p\u0026thinsp;=\u0026thinsp;0.000, p\u0026thinsp;=\u0026thinsp;0.034).\u003c/span\u003e \u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eSSA demonstrated superior hemodynamic stability with fewer and less severe hypotensive episodes and reduced vasopressor requirements. SSA may offer a safer alternative to CSA in obstetric anesthesia when performed by trained anesthetists.\u003c/span\u003e \u003c/p\u003e","manuscriptTitle":"Incidence of Hypotension in Obstetric Patients Undergoing Cesarean Section: Conventional vs. Segmental Spinal Anesthesia at Kassala Al- Saudi Maternity Hospital (July 2025 – December 2025)-A cross sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-09 16:42:18","doi":"10.21203/rs.3.rs-8457290/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-11T18:35:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-15T07:56:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-13T09:29:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5484710385549371736937761934690662077","date":"2026-04-13T08:53:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-10T12:47:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"310137041823157097500275066007356075979","date":"2026-04-10T04:48:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-08T19:01:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155313919110638189544661432271423654150","date":"2026-04-07T05:36:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"337624491271340338578168529343400419827","date":"2026-04-05T18:39:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-03T15:07:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-12T12:31:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-05T17:19:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-01T23:57:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-01-01T23:52:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8d9136ef-5528-47a8-a4d1-e1a8eaf7dd5d","owner":[],"postedDate":"April 9th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-11T18:35:16+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T18:39:19+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-09 16:42:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8457290","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8457290","identity":"rs-8457290","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}