Impact of Intraoperative Spinal Induced Hypotension on Neonatal Adverse Outcome During Caesarian Section at Wolaita Sodo University Comprehensive Specialized Hospital: 2023, a Prospective Observational Study

Impact of Intraoperative Spinal Induced Hypotension on Neonatal Adverse Outcome During Caesarian Section at Wolaita Sodo University Comprehensive Specialized Hospital: 2023, a Prospective Observational 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 Impact of Intraoperative Spinal Induced Hypotension on Neonatal Adverse Outcome During Caesarian Section at Wolaita Sodo University Comprehensive Specialized Hospital: 2023, a Prospective Observational Study Merkineh Meskele, Mihiretu Alemayew, Getahun Dendir, Abdulkadir Kedir, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4659176/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Incidence of maternal hypotension often reported and occurs after caesarian section due to multiple reasons. However, the effect of intraoperative spinal induced hypotension on neonatal adverse outcome during caesarian section hasn't been investigated adequately in Sub-Saharan Countries, including Ethiopia. This study aimed to investigate the effect of intraoperative spinal induced hypotension on neonatal adverse outcome during caesarian section. The researchers carried out a prospective cohort study from May 15-August 15, 2023. We selected 202 mothers using a convenience sampling method. We collected data by using a structured interviewer administered questionnaire. Once we ensured the collected data's completeness and consistency, we proceeded to enter it into Epidata 4.6. Then, we exported it to SPSS version 25 for analysis. Descriptive statistics were used to summarize data. Binary logistic regression analysis was used to determine the relative risk between neonatal outcome and maternal hypotension and other related features. By using confidence interval and p-value<0.05, the researchers determined the level of significance. Result: In this study, a total of 202 participants were given a response rate of 100%. The incidence proportion of adverse early neonatal outcome was 13.4%. Maternal hypotension at 5 minutes ARR maternal health condition (ARR: 3.9, (95%CI: 1.26, 12.2), APGAR score at one minute (ARR: 4.9, (95% CI: 1.7, 14.1)), parity (AOR: 4.2, (95% CI: 1.3, 13.5)), age of the mothers AOR: 5.1, (95% CI: 1.3, 19.5))., and birth weight (AOR: 3.6, (95% CI: 1.18, 10.9)) were identified as predictors of adverse early neonatal outcome. Conclusion: In this study, the incidence of adverse neonatal outcome was high. To reduce maternal hypotension after anesthesia, it is necessary to strengthen the monitoring of vital signs. To increase birth interval, it is necessary to expand family planning. Screening during antenatal and Intrapartum period should be promoted to reduce poor maternal health condition, and proper nutrition to reduce birth weight. Caesarean section Maternal Neonatal Hypotension unfavorable outcome Figures Figure 1 BACKGROUND The adverse neonatal outcome is defined as birth asphyxia, respiratory distress, birth trauma, hypothermia, meconium aspiration syndrome, neonatal intensive care admission and neonatal death ( 1 ). Cesarean section (CS) is a delivery of a fetus through abdominal incision followed by incision of the uterine wall( 2 ). The classification of a cesarean section as elective or emergency depends on the necessity. CS is an operation mainly developed to save a maternal life during difficult childbirth and recommended when vaginal delivery poses significant risk to mother and/or baby( 3 ). Researchers estimate that about 20 million CS deliveries occur each year worldwide, making it the most common abdominal surgery performed in adults ( 3 , 4 ). When performing a cesarean section delivery, professionals commonly opt for spinal anesthesia because it offers several advantages. These include reducing the risk of local anesthetic toxicity, providing a fast onset of local anesthetic effects, and ensuring the mother remains awake, able to interact with the neonate, and comfortable. Furthermore, it effectively relieves post-operative pain for mothers, thus avoiding any maternal morbidity and mortality associated with general anesthesia ( 5 ). The sympathectomy causes a reduction in the tone of splanchnic vasculature and the lower limbs, which is the physiological mechanism of spinal induced hypotension ( 6 ). Hypotension is a usual effect sympathetic motor block caused by spinal anesthesia for cesarean section results in maternal complications like nausea, vomiting, dyspnea frequently along with severe hypotension and adverse effects on fetus, including poor Apgar scores and umbilical acidosis has been related with severity and duration of hypotension( 4 ). A systolic blood pressure of less than 90 millimeters of mercury (mmHg) or diastolic of less than 60 mmHg is generally considered as being hypotension results from temporary sympathectomy leading to reduced preload and afterload, causing lower maternal mean arterial blood pressure and reduced utero-placental perfusion consequently contributes for adverse neonatal outcome( 5 , 6 ). The following conditions are considered being neonatal adverse outcomes: meconium aspiration syndrome, birth trauma, hypoxia at birth, respiratory distress, hypothermia, admission to critical care, and neonatal mortality( 7 ). Meconium-stained liquid is present in approximately 10 to 15% of newborns, and 3 to 9% of these babies go on to develop Meconium Aspiration Syndrome (MAS). Neonates with MAS are more likely to experience severe respiratory distress, asphyxia, and need to be admitted to the neonatal intensive care unit (NICU). It contributes to deaths as well( 8 ). It is the main reason for NICU admission and affects 8–47.6% of newborns in African nation( 4 , 9 ). Globally, an estimated 22.9 million cesarean procedures are performed each year, primarily to save the life of either the mother or the infant. However, at 1.77 deaths per 1,000 live births, global neonatal mortality post-cesarean section is three times higher than mortality following vaginal deliveries( 8 , 9 ). In sub-Saharan Africa, 8.8% of all deliveries are through cesarean section, falling within the 5–15% range recommended by the WHO. However, intrapartum neonatal mortality in sub-Saharan Africa accounts for 73% of global neonatal intrapartum deaths and neonatal mortality post-cesarean delivery in sub-Saharan Africa is higher than the global average( 4 , 10 ). Poor neonatal outcomes post-cesarean delivery has been defined as mortality, low APGAR scores or admission to the neonatal intensive care unit ( 11 ). Approximately 2.6 million newborns died in 2016, meaning 7,000 neonatal deaths every day. Sub-Saharan Africa countries accounted 38% of all newborn deaths and Ethiopia is among 5 countries contributing 50% of global neonatal deaths. Intrapartum associated events accounts 24% of neonatal deaths and it is probable to avert 80% of deaths by having accessible and quality health services, which access to cesarean delivery is one component. Diverse types of factors, for instance parity, distance amid institutions before interventions, meconium-stained amniotic fluid, type of anesthesia, birth weight, indications of cesarean sections, are associated with poor neonatal outcome after CS across the literature. When pharmacological prophylaxis is not utilized, hypotension is highly common during spinal anesthesia for elective Caesarean delivery (70–80%) ( 12 ). However, data on the effect of maternal factors on neonatal outcomes following CS is limited. On the other hand, because of multiple factors, hypotension occurs under and/or after CS among mothers practically. However, the effect of maternal hypotension on neonatal outcome during CS hardly been documented adequately in sub-Saharan Countries including Ethiopia. Thus, this study aims to investigate the effect of maternal hypotension on neonatal outcome during cesarean section at Wolaita Sodo University Comprehensive Specialized Hospital (WSUCSH), Southern Ethiopia. METHODS Study area and period This study was conducted from May-August, 2023 in Wolaita Sodo University Comprehensive and Specialized Hospital (WSUCSH), a public hospital in Sodo town, capital of the Wolaita zone. Sodo town is located about 327 km far from Addis Ababa. The estimated populations of Wolaita zone is about 2,114,383 from this, about 1,078,335 are males and 1,036,047 are females. WSUCSH is one of five public hospitals at Wolaita zone and the only comprehensive and specialized hospital of the zone, established in 1920 E.C as a Zonal Hospital in Wolaita zone. It is serving people in the catchment area of about 3 million people and hence it was incorporated into Wolaita Sodo University and currently it is serving as teaching, comprehensive and specialized hospital. The hospital is serving over 100,000 outpatient visitors in a year and around 350 functional beds with 800 average number of admission per month. According to the WSUCSH report total number of institutional delivery attended by skilled health personnel is 5368 in a year of 2014 E.C was reported based on the hospital report (13, 14). Study design An institutional based prospective observational study was conducted. Population Source population All neonates who delivered by cesarean section by spinal anesthesia at WSUCSH Study population All eligible neonates delivered by cesarean section under spinal anesthesia at WSUCSH Eligibility criteria Inclusion criteria All neonates who delivered by cesarean section under spinal anesthesia at WSUCSH Exclusion criteria Acute fetal distress Baseline maternal hypotension Intrauterine fetal death Pregnancies with bleeding Pregnancy induced hypertension Sample size determination and sampling technique Sample size was calculated by using assumption: proportion of adverse neonatal outcome of 64%, margin of error of 5%, and 95% of confidence interval (Z=1.96)(2). n0 = Z²x P x Q /d²,Z=1.96, P=0.64, Q=0.36, D=0.05, n0=355,N=465,n=n0/1+n0/N. Substituting the indicated assumptions in the above statistical formula; the overall sample size becomes 355, with the assumption of an infinite population. Since the study population was less than 10000, a correction formula was used. To minimize for finite population, the total mother given birth in the last year three months was taken as N=465 and no=355. The final sample size becomes n=355/1+355/465 =355/1.76=201.7≈202. Sampling technique: systematic random sampling technique was employed. The sampling frame was taken from the daily schedule list. Once the first individual was selected randomly by using the lottery method, the other individuals were selected using a systematic random sampling technique after getting the n th value (sampling interval) by dividing the total number of individuals by the sample size allocated. Last year, there were 465 women who underwent a C-section within three months of giving birth, based on the data. Accordingly, to the data every 2 nd (465/202) mother was included in this study. Data collection tool and procedures Data was collected from selected study participants using a pretested questionnaire of 5% from total sample size in order to maintain the quality and consistency of data. The questionnaire was address socio-demographic variables, maternal variables, anesthetic, surgical variables and neonatal condition. The mother was informed about the purpose and usefulness of the study, and then verbal consent was taken to ask willingness to participate before commencement of data collection period. Four trained midwives, who have previous experience on data collection, were collected data. A trained supervisor supervised them in order not to have difficulties during collection. Extensive data was collected on each mother who was included in the study and her newborn through interview and by abstraction of relevant data from medical records. Neonates; who get admitted to NICU, who are discharged from maternity ward and who stay in the maternity ward for maternal indication were followed for 24 hours. Study variables Dependent variable Early neonatal adverse outcome after CS Independent variables Maternal factors Maternal socio-demographic variables Previous obstetric history Antenatal care Obstetric and medical complication Indication of cesarean delivery and intraoperative events Intraoperative maternal hemodynamic status Blood pressure Pulse rate Anesthetic related factor Baricity of the drug Dose of the drug for spinal anesthesia Operation definitions Base line blood pressure : blood pressure recorded before induction of anesthesia (15). Hypotension: Is defined as systolic blood pressure below 100mmHg and reduction of systolic pressure of more than 20-30% from the baseline(3). Intraoperative spinal induced hypotension : decreased blood pressure by 20% and below from base line after spinal anesthesia (16). Induction of anesthesia to baby out time : the time interval between administrations of spinal anesthesia to baby out (17). Incision to baby out time : the time interval between skin incisions to baby out time. Adverse neonatal outcomes neonates with seizure, Stillbirth at delivery, the need for oxygen, admission to NICU for more than 24 hours and death within seven days were considered adverse early neonatal outcomes (18). Data Quality Control and Assurance A pretest was done by 5% of the study population at Sodo Christian Hospital to ensure the agreement of the data collection format with the need of the study and tested by alpha Cranach. Data qualities were also assured by giving adequate training and follow-up for data collectors and supervisors. The principal investigator and supervisors did intensive supervision during the whole period of data collection. Principal investigator also made random cross-checks for their completeness, accuracy, and consistency at the end of each day and corrective discussion was undertaken with all the research team members. Completed questionnaire was collected daily to avoid loss of data. Intensive supervision and daily information exchange including telephone was used as a means to correct problems during the data collection. Data management and analysis plan The data was cleaned, coded and entered in to Epidata 4.6, and exported to SPSS 25 for further analysis. Descriptive statistics was computed to summarize data. Frequencies with percentages were used for categorical data and means with standard deviation, median and mode were used for continuous variables based on the nature of the data (normal or non-normal distributions). Outlier of the data was checked using standardized residual tests and multi-collinearity for continuous data was checked by variance inflation factor (VIF<10) and tolerance. Categorical variables were compared using chi-square test. Binary logistic regression was performed to determine the relative risk between dependent and independent variables. In the bivariate logistic regression, variables with p-value <0.25 were selected and entered in to multivariable logistic regression. In the multivariable binary logistic regression analysis, variables with p-value <0.05 were considered as statistically significant. RESULTS Socio-demographic characteristics of the participants In this study, 202 study subjects participated with a response rate of 100%. The mean age of the respondents was 26.54(SD=5.02). One fifth of the respondents were adolescent women (table1). Medical and obstetric characteristics of the respondents According to this study, more than three fourth of the respondents had a gestational age of 37-40 while 14.9% had preterm neonates. Majority (78.2%) of the participant's loss expected amount of blood during cesarean section (table2). Characteristics of the neonates According to this study, the majority of neonates were male 113 (55.9), and had a normal birth weight of 155(76.7). Regarding to the Apgar score at first minute, 68(33.7) neonates had less than six Apgar scores (table3). Incidence of adverse early neonatal outcome According to this study, the incidence proportion of adverse early neonatal outcome was 13.4% (95% CI: 9.2, 17.8). Predictors of the unfavorable outcome of neonates of women who underwent after Caesarean section In bi-variate binary logistic regression, variables: age of the respondents, residence parity, gr-avidity, maternal health condition, maternal hypotension after anesthesia at ten minutes, maternal hypotension after anesthesia at five minutes, Apgar score at one minute, and weight of the neonates had p-value of <0.25 were became candidates for multivariate binary logistic regression. In multivariate binary logistic regression analysis, age of the respondents, parity, maternal health condition, and maternal hypotension after anesthesia at five minutes were predictors of unfavorable outcome of neonates. The relative risk of unfavorable outcome of neonates was 5 times higher among adolescents who underwent Caesarean section when compared to adult women (ARR: 5.1, (95% CI: 1.3, 19.5)). The likelihood of unfavorable outcome was 4.2 times higher for women who had more than three children when compared to women who had less than three children (ARR: 4.2, (95% CI: 1.3, 13.5)). Maternal health condition and maternal hypotension after anesthesia at five minutes was identified as a predictor for unfavorable outcome of neonates. The odd of unfavorable outcome was 3.9 times higher for women who had poor health condition when compared to their counterparts (ARR: 3.9, (95%CI: 1.26, 12.2). Moreover, the risk of unfavorable outcome of neonates was higher after application of anesthesia at five minutes. The likelihood of unfavorable outcome was 4.2 times higher among women after application of anesthesia after five minutes when compared to their counterparts. Apgar score at one minute and birth weight of neonates were predictors of unfavorable outcome of neonates. The odds of unfavorable outcome of neonates were 4.9 times higher for neonates with <5 Apgar score at one minute when compared to their counterparts (ARR: 4.9, (95%CI: 1.7, 14.1)). The odds of unfavorable outcome of neonates were 3.6 times higher for neonates with birth weight of 2.5KG (ARR: 3.6, (95% CI: 1.18, 10.9)) (table4). DISCUSSION This study aimed to assess the effects of maternal hypotension and other predictors of an unfavorable outcome of neonates of women who underwent Caesarean section. Therefore, a total of 202 neonates were followed for 24 hours. The incidence proportion of unfavorable early neonatal outcome was 13.4%. The risk of unfavorable neonatal outcome among hypotensive women was four fold higher when compared to normotensive women. Age of the women, parity, maternal health condition, Apgar score at fifth minute, and birth weight were identified as predictors of unfavorable outcome of neonate. According to this study, the incidence proportion of adverse early neonatal outcome was 13.4%. This finding is higher than a study done in Rwanda (9%) (19), and Addis Ababa (4%)(20). This difference might be due to variation in health coverage, quality of care provided to the women during antenatal care follow up. This finding implies that the need of leveling up the coverage and quality of maternal health services. However, this finding is much lower than a prospective observational study done in Turkey (22.9%)(21), and a study done in the Sidama region, Hawassa, Ethiopia (26.7)(22). This variation might be due to the differences in sample size, study period, and study area. According to this study, maternal hypotension after anesthesia is varying along with time. Maternal hypotension at one, five, ten and fifteen minutes was 14.9%, 47.5% 44.2%, and 33.2% respectively. However, only maternal hypotension at five minutes was significantly associated with adverse neonatal outcome. The risk of adverse neonatal outcome is four fold for women who had hypotension at fifteen minutes. This finding was supported by a study done in Addis Ababa(14). This finding implies that the need for extensive checkup of vital signs and resuscitation before inducing anesthesia. In this study, women who had more than three children increased the risk of an unfavorable neonatal outcome. This finding was in line with a study done in Rwanda (19). This might be due to the multiparty poses the maternal depletion in terms of nutrition and other chronic disease. This in turn might leads to unfavorable outcome. However, a study done in Iran found that neonates born primparous mothers were 1.5 times more likely develop adverse early neonatal outcome when compared to babies born multipara (21). This might be due to variation in the age of the respondents in the former study. Findings of this study support this; young women were more likely at risk for developing adverse neonatal outcome. Adverse neonatal outcome was higher among neonates with low birth weight (<2.5Kg). A study done in Hawassa supported this finding (22). They're the odds of adverse neonatal outcome were 14 times higher for neonates with low birth weight. This finding implies that the need of adequate nutritional education and nutrition during antenatal care period. According to this study, maternal health condition was identified as one of a determinant for adverse neonatal outcome. A mother with poor health condition has a higher risk for adverse neonatal outcome. This finding was in line with a study done in Rwanda (19). This finding implies that the need to investigate mothers during the antepartum, and intrapartum period to screen and manage according to WHO protocol (21). Limitation and strength of this study There was limited evidence on the effects of maternal hypotension on early adverse neonatal outcome in this study area. Thus, it adds inputs at the local level. It also improves prenatal service implementation at health facilities. Since, this study was follow up it might indicate cause and effect relation. However, this study was conducted in one hospital because of resource issue. CONCLUSION AND RECOMMENDATION Conclusion The incidence proportion of adverse neonatal outcome among women who underwent cesarean section was high. Maternal hypotension after anesthesia, age of mother, parity, weight of neonate, Apgar score at one minute, and maternal health conditions were predictors of adverse early neonatal outcome. Maternal hypotension after anesthesia was an increase with time. However, there was no significant association of the baseline blood pressure of the mother with an early adverse neonatal outcome. Recommendation Health professionals at WSUCH should monitor vital signs frequently and take measurement to reduce maternal hypotension after induction of anesthesia. In order to improve access to lifesaving care for women and neonates, there is a pressing need for implementation of existing strategies to decrease adverse early neonatal outcome. The concerned bodies of Wolaita Zone should give attention to reduce the number of teenage pregnancy through expanding access to family planning and increasing time to first pregnancy after marriage for teenagers The WSUCH should give direction to health professionals to give attention to antenatal and intrapartum care to reduce poor maternal health condition through screening and managing pregnancy-related medical conditions. Health facilities in the Wolaita zone should give information on nutrition to pregnant women during an antenatal period in order to reduce low birth weight. Abbreviations CS…………………. Cesarean section WHO………………World Health Organization WSUCSH…………. Wolaita Sodo University Comprehensive Specialized Hospital Declarations Au thor Contribution MM and SS were involved in the conception, design, analysis, interpretation, report and manuscript writing; MA and GD had participated in the conception, design, analysis, interpretation, and report writing. AK and SR were involved in designing the study, analysis, report and manuscript writing Ethics approval and consent to participant Ethical approval was obtained from the Institutional Review board of Wolaita Sodo University, College of Health Sciences and Medicine, with a protocol unique No of CHSM/ERC/03/15. Written informed consent has taken from each participant and all participants’ privacy and information was kept confidential. Consent for publication Informed written consent has taken for publication Availability of data and materials The data that support the findings of this study are available from the corresponding authors upon reasonable request. Competing interests The authors declare that they have no competing interests. All authors have read and approved the final manuscript. Funding Wolaita Sodo University had covered all the costs for this work. ACKNOWLEDGEMENTS Foremost, I would like to thank all participated on this paper. References Tefera M, Assefa N, Roba KT, L. G. Adverse Neonatal Outcome are MoreCommon among Babies Born byCesarean Section than Naturally BornBabies at Public Hospitals in EasternEthiopia: A Comparative Prospective Follow-Up Study at Eastern Ethiopia. Global Pediatric Health. 2021;8:1-12. Khader PYS, Batieha PA, Khader DS, Jalam DMA, DIA. A. Rate, causes, and risk factors of caesarean section in north of Jordan and its associated maternal and perinatal risks. . Jordan University of Science and Technology. 2020. Abdissa Z, Awoke T, Belayneh T, YT. Y. Birth outcome after caesarean section among mothers who delivered by caesarean section under general and spinal anesthesia at Gondar University teaching hos pital north-west Ethiopia. . J Anesth Clin Res. 2013;4(7). T. S. Efect Of Prophylactic Ephedrine On Blood Pressure Changes During Cesarean Section Under Spinal Anesthesia At Tikur Anbesa Specialized Hospital, Ethiopia, 2018: Prospective Cohort Study: . Addis Ababa University; 2018. 2018. T. M. Incidence of Spinal Anesthesia Induced Severe Hypotension among the Pregnant Women Undergoing Cesarean Section at Muhima Hospital. . Rwanda Journal of Medicine and Health Sciences 2022;5(1). Tang O, Foti K, Miller III ER, Appel LJ, SP. J. Factors associated with physician recommendation of home blood pressure monitoring and blood pressure in the US population. . American journal of hypertension 2020;33(9):852-9. Maayan-Metzger A, Schushan-Eisen I, Todris L, Etchin A, J. K. Maternal hypotension during elective cesarean section and short-term neonatal outcome. . American journal of obstetrics and gynecology. 2010;202(1):56.e1-e5. Tadesse E, Adane M, M. A. Caesarean section deliveries at Tikur Anbessa Teaching Hospital, Ethiopia. . Ethiop J Health Dev 2003;2:37-41. Tashfeen k, M.Patel, Hamdi I, IH A-B, A-Y. M. Decision-to-delivery time intervals in emergency caesarean section cases: repeated cross-sectional study from Oman. . Sultan Qaboos University Medical Journa. 2017;27(1). M. S. Effects Of General Versus Spinal Anesthesia Over Apgar Score Of Newborns Delivered By Cesarean Sections And Factors Associated With Apgar Score From January To March 2016 At Gandhi Memorial Hospital, Addis Ababa: . Addis Ababa University. 2016. . !!! INVALID CITATION !!! (3, 4, 13). Mercier FJ, Augè M, Hoffmann C, Fischer C, A. LG. Maternal hypotension during spinal anesthesia for caesarean delivery. . 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Tables Table 1 socio-demographic characteristics of mothers who gave birth through Cesarean section (CS) in WSUCSH, from May to August 2023 Variables Category Frequency (%) Percentages Age of mothers 30 40 19.8 Education status Secondary and 99 49 Above Primary 54 26.7 Illiterate 49 24.3 Occupation Housewife 83 41.1 Merchant 27 13.4 Student 57 28.2 Government 35 17.3 Employed Address Urban 97 48 Rural 105 52 Table 2 medical and obstetric characteristics of mothers who gave birth through Caesarian section (CS) in WSUCH, from May to August 2023 Variables Category Frequency Percentages Gestation age 40 18 8.9 Parity 3 child 23 11.4 Baseline blood pressure Normal 202 100 Estimated blood loss 500-1000ml 158 78.2 >1000ml 44 21.8 Prophylactic vasopressor used Yes 15 7.4 No 187 82.6 Duration of surgery (minutes) 45 106 52.5 Route of utero-tonic drug Intravenous 24 11.9 administration Intramuscular 178 78.1 Maternal hypotension after No 135 66.8 fifteen minutes Yes 67 33.2 Maternal hypotension after ten No 113 55.9 Minutes Yes 89 44.1 Maternal hypotension after five No 106 52.5 Minute Yes 96 47.5 Maternal hypotension after one No 172 85.1 Minutes Yes 30 14.9 Maternal health condition No 160 79.2 Yes 42 20.8 Table 3 the characteristics of neonates at WSUCH, from May to August2023 Variables Category Frequency Percentages Sex Male 113 55.9 Female 89 44.1 Birth weight =2.5-4KG 155 76.7 Pre-anesthesia heart beat 80-120 109 54 120 42 25.7 Table 4 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table4.docx Cite Share Download PDF Status: Posted Version 1 posted 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-4659176","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":327702118,"identity":"4ed55b07-d0d8-4b4b-8846-239d5ebe6fb8","order_by":0,"name":"Merkineh 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university","correspondingAuthor":false,"prefix":"","firstName":"Salman","middleName":"","lastName":"Reshad","suffix":""},{"id":327702123,"identity":"93581d42-6d89-47c6-8c3a-3a7d40e2f773","order_by":5,"name":"Sintayehu Samuel","email":"","orcid":"","institution":"wachemo university","correspondingAuthor":false,"prefix":"","firstName":"Sintayehu","middleName":"","lastName":"Samuel","suffix":""}],"badges":[],"createdAt":"2024-06-29 11:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4659176/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4659176/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60944494,"identity":"a6721917-2668-4c4d-958e-b91bf5bb33ad","added_by":"auto","created_at":"2024-07-23 22:11:38","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":30838,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eConceptual framework after review literature\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4659176/v1/e372f6914e186aff75cff4b8.jpg"},{"id":63455888,"identity":"c4920687-193a-4ae1-85f1-654f68b5458c","added_by":"auto","created_at":"2024-08-28 10:22:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":655373,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4659176/v1/571a3503-42af-49cd-97b3-a80fa6fb7db7.pdf"},{"id":60944496,"identity":"048cd8c5-656b-4dba-9e10-1fb248d02d03","added_by":"auto","created_at":"2024-07-23 22:11:38","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20180,"visible":true,"origin":"","legend":"","description":"","filename":"Table4.docx","url":"https://assets-eu.researchsquare.com/files/rs-4659176/v1/8047822c2e409c6f95efcfa4.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eImpact of Intraoperative Spinal Induced Hypotension on Neonatal Adverse Outcome During Caesarian Section at Wolaita Sodo University Comprehensive Specialized Hospital: 2023, a Prospective Observational Study\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eThe adverse neonatal outcome is defined as birth asphyxia, respiratory distress, birth trauma, hypothermia, meconium aspiration syndrome, neonatal intensive care admission and neonatal death (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCesarean section (CS) is a delivery of a fetus through abdominal incision followed by incision of the uterine wall(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The classification of a cesarean section as elective or emergency depends on the necessity. CS is an operation mainly developed to save a maternal life during difficult childbirth and recommended when vaginal delivery poses significant risk to mother and/or baby(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Researchers estimate that about 20\u0026nbsp;million CS deliveries occur each year worldwide, making it the most common abdominal surgery performed in adults (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhen performing a cesarean section delivery, professionals commonly opt for spinal anesthesia because it offers several advantages. These include reducing the risk of local anesthetic toxicity, providing a fast onset of local anesthetic effects, and ensuring the mother remains awake, able to interact with the neonate, and comfortable. Furthermore, it effectively relieves post-operative pain for mothers, thus avoiding any maternal morbidity and mortality associated with general anesthesia (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe sympathectomy causes a reduction in the tone of splanchnic vasculature and the lower limbs, which is the physiological mechanism of spinal induced hypotension (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Hypotension is a usual effect sympathetic motor block caused by spinal anesthesia for cesarean section \u003cspan refid=\"Sec19\" class=\"InternalRef\"\u003eresults\u003c/span\u003e in maternal complications like nausea, vomiting, dyspnea frequently along with severe hypotension and adverse effects on fetus, including poor Apgar scores and umbilical acidosis has been related with severity and duration of hypotension(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA systolic blood pressure of less than 90 millimeters of mercury (mmHg) or diastolic of less than 60 mmHg is generally considered as being hypotension results from temporary sympathectomy leading to reduced preload and afterload, causing lower maternal mean arterial blood pressure and reduced utero-placental perfusion consequently contributes for adverse neonatal outcome(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe following conditions are considered being neonatal adverse outcomes: meconium aspiration syndrome, birth trauma, hypoxia at birth, respiratory distress, hypothermia, admission to critical care, and neonatal mortality(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Meconium-stained liquid is present in approximately 10 to 15% of newborns, and 3 to 9% of these babies go on to develop Meconium Aspiration Syndrome (MAS). Neonates with MAS are more likely to experience severe respiratory distress, asphyxia, and need to be admitted to the neonatal intensive care unit (NICU). It contributes to deaths as well(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). It is the main reason for NICU admission and affects 8\u0026ndash;47.6% of newborns in African nation(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobally, an estimated 22.9\u0026nbsp;million cesarean procedures are performed each year, primarily to save the life of either the mother or the infant. However, at 1.77 deaths per 1,000 live births, global neonatal mortality post-cesarean section is three times higher than mortality following vaginal deliveries(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In sub-Saharan Africa, 8.8% of all deliveries are through cesarean section, falling within the 5\u0026ndash;15% range recommended by the WHO. However, intrapartum neonatal mortality in sub-Saharan Africa accounts for 73% of global neonatal intrapartum deaths and neonatal mortality post-cesarean delivery in sub-Saharan Africa is higher than the global average(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Poor neonatal outcomes post-cesarean delivery has been defined as mortality, low APGAR scores or admission to the neonatal intensive care unit (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eApproximately 2.6\u0026nbsp;million newborns died in 2016, meaning 7,000 neonatal deaths every day. Sub-Saharan Africa countries accounted 38% of all newborn deaths and Ethiopia is among 5 countries contributing 50% of global neonatal deaths. Intrapartum associated events accounts 24% of neonatal deaths and it is probable to avert 80% of deaths by having accessible and quality health services, which access to cesarean delivery is one component.\u003c/p\u003e \u003cp\u003eDiverse types of factors, for instance parity, distance amid institutions before interventions, meconium-stained amniotic fluid, type of anesthesia, birth weight, indications of cesarean sections, are associated with poor neonatal outcome after CS across the literature.\u003c/p\u003e \u003cp\u003eWhen pharmacological prophylaxis is not utilized, hypotension is highly common during spinal anesthesia for elective Caesarean delivery (70\u0026ndash;80%) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, data on the effect of maternal factors on neonatal outcomes following CS is limited. On the other hand, because of multiple factors, hypotension occurs under and/or after CS among mothers practically. However, the effect of maternal hypotension on neonatal outcome during CS hardly been documented adequately in sub-Saharan Countries including Ethiopia. Thus, this study aims to investigate the effect of maternal hypotension on neonatal outcome during cesarean section at Wolaita Sodo University Comprehensive Specialized Hospital (WSUCSH), Southern Ethiopia.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eStudy\u0026nbsp;area and period\u003c/p\u003e\n\u003cp\u003eThis study was conducted from May-August, 2023 in Wolaita Sodo University Comprehensive and Specialized Hospital (WSUCSH), a public hospital in Sodo town, capital of the Wolaita zone. Sodo town is located about 327 km far from Addis Ababa. The estimated populations of Wolaita zone is about 2,114,383 from this, about 1,078,335 are males and 1,036,047 are females. WSUCSH is one of five public hospitals at Wolaita zone and the only comprehensive and specialized hospital of the zone, established in 1920 E.C as a Zonal Hospital in Wolaita zone. It is serving people in the catchment area of about 3 million people and hence it was incorporated into Wolaita Sodo University and currently it is serving as teaching, comprehensive and specialized hospital.\u003c/p\u003e\n\u003cp\u003eThe hospital is serving over 100,000 outpatient visitors in a year and around 350 functional beds with 800 average number of admission per month. According to the WSUCSH report total number of institutional delivery attended by skilled health personnel is 5368 in a year of 2014 E.C was reported based on the hospital report (13, 14).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn institutional based prospective observational study was conducted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll neonates who delivered by cesarean section by spinal anesthesia at WSUCSH\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll eligible neonates delivered by cesarean section under spinal anesthesia at WSUCSH\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll neonates who delivered by cesarean section under spinal anesthesia at WSUCSH\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcute fetal distress\u003c/p\u003e\n\u003cp\u003eBaseline maternal hypotension\u003c/p\u003e\n\u003cp\u003eIntrauterine fetal death\u003c/p\u003e\n\u003cp\u003ePregnancies with bleeding\u003c/p\u003e\n\u003cp\u003ePregnancy induced hypertension\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size determination and sampling technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSample size was calculated by using assumption: proportion of adverse neonatal outcome of 64%, margin of error of 5%, and 95% of confidence interval (Z=1.96)(2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003en0 = Z\u0026sup2;x P x Q /d\u0026sup2;,Z=1.96, P=0.64, Q=0.36, D=0.05, n0=355,N=465,n=n0/1+n0/N.\u003c/p\u003e\n\u003cp\u003eSubstituting the indicated assumptions in the above statistical formula; the overall sample size becomes 355, with the assumption of an infinite population. Since the study population was less than 10000, a correction formula was used. To minimize for finite population, the total mother given birth in the last year three months was taken as N=465 and no=355. The final sample size becomes n=355/1+355/465 =355/1.76=201.7\u0026asymp;202.\u003c/p\u003e\n\u003cp\u003eSampling technique: systematic random sampling technique was employed. The sampling frame was taken from the daily schedule list.\u003c/p\u003e\n\u003cp\u003eOnce the first individual was selected randomly by using the lottery method, the other individuals were selected using a systematic random sampling technique after getting the n\u003csup\u003eth\u003c/sup\u003e value (sampling interval) by dividing the total number of individuals by the sample size allocated. Last year, there were 465 women who underwent a C-section within three months of giving birth, based on the data. Accordingly, to the data every 2\u003csup\u003end\u0026nbsp;\u003c/sup\u003e(465/202) mother was included in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection tool and procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData was collected from selected study participants using a pretested questionnaire of 5% from total sample size in order to maintain the quality and consistency of data. The questionnaire was address socio-demographic variables, maternal variables, anesthetic, surgical variables and neonatal condition. The mother was informed about the purpose and usefulness of the study, and then verbal consent was taken to ask willingness to participate before commencement of data collection period.\u003c/p\u003e\n\u003cp\u003eFour trained midwives, who have previous experience on data collection, were collected data. A trained supervisor supervised them in order not to have difficulties during collection. Extensive data was collected on each mother who was included in the study and her newborn through interview and by abstraction of relevant data from medical records. Neonates; who get admitted to NICU, who are discharged from maternity ward and who stay in the maternity ward for maternal indication were followed for 24 hours.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDependent variable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEarly neonatal adverse outcome after CS\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndependent variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMaternal factors\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eMaternal socio-demographic variables\u003c/li\u003e\n \u003cli\u003ePrevious obstetric history\u003c/li\u003e\n \u003cli\u003eAntenatal care\u003c/li\u003e\n \u003cli\u003eObstetric and medical complication\u003c/li\u003e\n \u003cli\u003eIndication of cesarean delivery and intraoperative events\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eIntraoperative maternal hemodynamic status\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eBlood pressure\u003c/li\u003e\n \u003cli\u003ePulse rate\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAnesthetic related factor\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eBaricity of the drug\u003c/li\u003e\n \u003cli\u003eDose of the drug for spinal anesthesia\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eOperation definitions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBase line blood pressure\u003c/strong\u003e: blood pressure recorded before induction of anesthesia (15).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypotension:\u003c/strong\u003e Is defined as systolic blood pressure below 100mmHg and reduction of systolic pressure of more than 20-30% from the baseline(3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntraoperative spinal induced hypotension\u003c/strong\u003e: decreased blood pressure by 20% and below from base line after spinal anesthesia (16).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInduction of anesthesia to baby out time\u003c/strong\u003e: the time interval between administrations of spinal anesthesia to baby out (17).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIncision to baby out time\u003c/strong\u003e: the time interval between skin incisions to baby out time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdverse neonatal outcomes\u003c/strong\u003e neonates with seizure, Stillbirth at delivery, the need for oxygen, admission to NICU for more than 24 hours and death within seven days were considered adverse early neonatal outcomes (18).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Quality Control and Assurance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA pretest was done by 5% of the study population at Sodo Christian Hospital to ensure the agreement of the data collection format with the need of the study and tested by alpha Cranach. Data qualities were also assured by giving adequate training and follow-up for data collectors and supervisors. The principal investigator and supervisors did intensive supervision during the whole period of data collection. Principal investigator also made random cross-checks for their completeness, accuracy, and consistency at the end of each day and corrective discussion was undertaken with all the research team members. Completed questionnaire was collected daily to avoid loss of data. Intensive supervision and daily information exchange including telephone was used as a means to correct problems during the data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData management and analysis plan\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data was cleaned, coded and entered in to Epidata 4.6, and exported to SPSS 25 for further analysis. Descriptive statistics was computed to summarize data. Frequencies with percentages were used for categorical data and means with standard deviation, median and mode were used for continuous variables based on the nature of the data (normal or non-normal distributions). Outlier of the data was checked using standardized residual tests and multi-collinearity for continuous data was checked by variance inflation factor (VIF\u0026lt;10) and tolerance. Categorical variables were compared using chi-square test. Binary logistic regression was performed to determine the relative risk between dependent and independent variables. In the bivariate logistic regression, variables with p-value \u0026lt;0.25 were selected and entered in to multivariable logistic regression. In the multivariable binary logistic regression analysis, variables with p-value \u0026lt;0.05 were considered as statistically significant.\u0026nbsp;\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eSocio-demographic characteristics of the participants\u003c/p\u003e\n\u003cp\u003eIn this study, 202 study subjects participated with a response rate of 100%. The mean age of the respondents was 26.54(SD=5.02). One fifth of the respondents were adolescent women (table1).\u003c/p\u003e\n\u003cp\u003eMedical and obstetric characteristics of the respondents\u003c/p\u003e\n\u003cp\u003eAccording to this study, more than three fourth of the respondents had a gestational age of 37-40 while 14.9% had preterm neonates. Majority (78.2%) of the participant\u0026apos;s loss expected amount of blood during cesarean section (table2).\u003c/p\u003e\n\u003cp\u003eCharacteristics of the neonates\u003c/p\u003e\n\u003cp\u003eAccording to this study, the majority of neonates were male 113 (55.9), and had a normal birth weight of 155(76.7). Regarding to the Apgar score at first minute, 68(33.7) neonates had less than six Apgar scores (table3).\u003c/p\u003e\n\u003cp\u003eIncidence of adverse early neonatal outcome\u003c/p\u003e\n\u003cp\u003eAccording to this study, the incidence proportion of adverse early neonatal outcome was 13.4% (95% CI: 9.2, 17.8).\u003c/p\u003e\n\u003cp\u003ePredictors of the unfavorable outcome of neonates of women who underwent after Caesarean section\u003c/p\u003e\n\u003cp\u003eIn bi-variate binary logistic regression, variables: age of the respondents, residence parity, gr-avidity, maternal health condition, maternal hypotension after anesthesia at ten minutes, maternal hypotension after anesthesia at five minutes, Apgar score at one minute, and weight of the neonates had p-value of \u0026lt;0.25 were became candidates for multivariate binary logistic regression.\u003c/p\u003e\n\u003cp\u003eIn multivariate binary logistic regression analysis, age of the respondents, parity, maternal health condition, and maternal hypotension after anesthesia at five minutes were predictors of unfavorable outcome of neonates.\u003c/p\u003e\n\u003cp\u003eThe relative risk of unfavorable outcome of neonates was 5 times higher among adolescents who underwent Caesarean section when compared to adult women (ARR: 5.1, (95% CI: 1.3, 19.5)).\u003c/p\u003e\n\u003cp\u003eThe likelihood of unfavorable outcome was 4.2 times higher for women who had more than three children when compared to women who had less than three children (ARR: 4.2, (95% CI: 1.3, 13.5)).\u003c/p\u003e\n\u003cp\u003eMaternal health condition and maternal hypotension after anesthesia at five minutes was identified as a predictor for unfavorable outcome of neonates. The odd of unfavorable outcome was 3.9 times higher for women who had poor health condition when compared to their counterparts (ARR: 3.9, (95%CI: 1.26, 12.2). Moreover, the risk of unfavorable outcome of neonates was higher after application of anesthesia at five minutes. The likelihood of unfavorable outcome was 4.2 times higher among women after application of anesthesia after five minutes when compared to their counterparts.\u003c/p\u003e\n\u003cp\u003eApgar score at one minute and birth weight of neonates were predictors of unfavorable outcome of neonates. The odds of unfavorable outcome of neonates were 4.9 times higher for neonates with \u0026lt;5 Apgar score at one minute when compared to their counterparts (ARR: 4.9, (95%CI: 1.7, 14.1)). The odds of unfavorable outcome of neonates were 3.6 times higher for neonates with birth weight of \u0026lt;=2.5KG when compared to neonates who had birth weight of \u0026gt;2.5KG (ARR: 3.6, (95% CI: 1.18, 10.9)) (table4).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study aimed to assess the effects of maternal hypotension and other predictors of an unfavorable outcome of neonates of women who underwent Caesarean section. Therefore, a total of 202 neonates were followed for 24 hours. The incidence proportion of unfavorable early neonatal outcome was 13.4%. The risk of unfavorable neonatal outcome among hypotensive women was four fold higher when compared to normotensive women. Age of the women, parity, maternal health condition, Apgar score at fifth minute, and birth weight were identified as predictors of unfavorable outcome of neonate.\u003c/p\u003e\n\u003cp\u003eAccording to this study, the incidence proportion of adverse early neonatal outcome was 13.4%. This finding is higher than a study done in Rwanda (9%) (19), and Addis Ababa (4%)(20). This difference might be due to variation in health coverage, quality of care provided to the women during antenatal care follow up. This finding implies that the need of leveling up the coverage and quality of maternal health services. However, this finding is much lower than a prospective observational study done in Turkey (22.9%)(21), and a study done in the Sidama region, Hawassa, Ethiopia (26.7)(22). This variation might be due to the differences in sample size, study period, and study area.\u003c/p\u003e\n\u003cp\u003eAccording to this study, maternal hypotension after anesthesia is varying along with time. Maternal hypotension at one, five, ten and fifteen minutes was 14.9%, 47.5% 44.2%, and 33.2% respectively. However, only maternal hypotension at five minutes was significantly associated with adverse neonatal outcome. The risk of adverse neonatal outcome is four fold for women who had hypotension at fifteen minutes. This finding was supported by a study done in Addis Ababa(14). This finding implies that the need for extensive checkup of vital signs and resuscitation before inducing anesthesia.\u003c/p\u003e\n\u003cp\u003eIn this study, women who had more than three children increased the risk of an unfavorable neonatal outcome. This finding was in line with a study done in Rwanda (19). This might be due to the multiparty poses the maternal depletion in terms of nutrition and other chronic disease. This in turn might leads to unfavorable outcome. However, a study done in Iran found that neonates born primparous mothers were 1.5 times more likely develop adverse early neonatal outcome when compared to babies born multipara (21). This might be due to variation in\u003c/p\u003e\n\u003cp\u003ethe age of the respondents in the former study. Findings of this study support this; young women were more likely at risk for developing adverse neonatal outcome.\u003c/p\u003e\n\u003cp\u003eAdverse neonatal outcome was higher among neonates with low birth weight (\u0026lt;2.5Kg). A study done in Hawassa supported this finding (22). They're the odds of adverse neonatal outcome were 14 times higher for neonates with low birth weight. This finding implies that the need of adequate nutritional education and nutrition during antenatal care period.\u003c/p\u003e\n\u003cp\u003eAccording to this study, maternal health condition was identified as one of a determinant for adverse neonatal outcome. A mother with poor health condition has a higher risk for adverse neonatal outcome. This finding was in line with a study done in Rwanda (19). This finding implies that the need to investigate mothers during the antepartum, and intrapartum period to screen and manage according to WHO protocol (21).\u003c/p\u003e\n\u003ch2\u003eLimitation and strength of this study\u003c/h2\u003e\n\u003cp\u003eThere was limited evidence on the effects of maternal hypotension on early adverse neonatal outcome in this study area. Thus, it adds inputs at the local level. It also improves prenatal service implementation at health facilities. Since, this study was follow up it might indicate cause and effect relation. However, this study was conducted in one hospital because of resource issue.\u003c/p\u003e"},{"header":"CONCLUSION AND RECOMMENDATION","content":"\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe incidence proportion of adverse neonatal outcome among women who underwent cesarean section was high. Maternal hypotension after anesthesia, age of mother, parity, weight of neonate, Apgar score at one minute, and maternal health conditions were predictors of adverse early neonatal outcome. Maternal hypotension after anesthesia was an increase with time. However, there was no significant association of the baseline blood pressure of the mother with an early adverse neonatal outcome.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHealth professionals at WSUCH should monitor vital signs frequently and take measurement to reduce maternal hypotension after induction of anesthesia.\u003c/p\u003e\n\u003cp\u003eIn order to improve access to lifesaving care for women and neonates, there is a pressing need for implementation of existing strategies to decrease adverse early neonatal outcome.\u003c/p\u003e\n\u003cp\u003eThe concerned bodies of Wolaita Zone should give attention to reduce the number of teenage pregnancy through expanding access to family planning and increasing time to first pregnancy after marriage for teenagers\u003c/p\u003e\n\u003cp\u003eThe WSUCH should give direction to health professionals to give attention to antenatal and intrapartum care to reduce poor maternal health condition through screening and managing pregnancy-related medical conditions.\u003c/p\u003e\n\u003cp\u003eHealth facilities in the Wolaita zone should give information on nutrition to pregnant women during an antenatal period in order to reduce low birth weight.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCS\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;. Cesarean section\u003c/p\u003e\n\u003cp\u003eWHO\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;World Health Organization\u003c/p\u003e\n\u003cp\u003eWSUCSH\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;. Wolaita Sodo University Comprehensive Specialized Hospital\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAu\u003c/strong\u003e\u003cstrong\u003ethor\u0026nbsp;Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMM and SS were involved in the conception, design, analysis, interpretation, report and manuscript writing;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMA and GD had participated in the conception, design, analysis, interpretation, and report writing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAK and SR were involved in designing the study, analysis, report and manuscript writing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participant\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Review board of Wolaita Sodo University, College of Health Sciences and Medicine, with a protocol unique No of \u003cstrong\u003eCHSM/ERC/03/15.\u003c/strong\u003e Written informed consent has taken from each participant and all participants\u0026rsquo; privacy and information was kept confidential.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed written consent has taken for publication\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding authors upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;All authors have\u0026nbsp;read and\u0026nbsp;approved the\u0026nbsp;final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWolaita Sodo University had covered all the costs for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eForemost, I would like to thank all participated on this paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTefera M, Assefa N, Roba KT, L. G. Adverse Neonatal Outcome are MoreCommon among Babies Born byCesarean Section than Naturally BornBabies at Public Hospitals in EasternEthiopia: A Comparative Prospective Follow-Up Study at Eastern Ethiopia. Global Pediatric Health. 2021;8:1-12.\u003c/li\u003e\n\u003cli\u003eKhader PYS, Batieha PA, Khader DS, Jalam DMA, DIA. A. Rate, causes, and risk factors of caesarean section in north of Jordan and its associated maternal and perinatal risks. . Jordan University of Science and Technology. 2020.\u003c/li\u003e\n\u003cli\u003eAbdissa Z, Awoke T, Belayneh T, YT. Y. Birth outcome after caesarean section among mothers who delivered by caesarean section under general and spinal anesthesia at Gondar University teaching hos pital north-west Ethiopia. . J Anesth Clin Res. 2013;4(7).\u003c/li\u003e\n\u003cli\u003eT. S. Efect Of Prophylactic Ephedrine On Blood Pressure Changes During Cesarean Section Under Spinal Anesthesia At Tikur Anbesa Specialized Hospital, Ethiopia, 2018: Prospective Cohort Study: . Addis Ababa University; 2018. 2018.\u003c/li\u003e\n\u003cli\u003eT. M. Incidence of Spinal Anesthesia Induced Severe Hypotension among the Pregnant Women Undergoing Cesarean Section at Muhima Hospital. . Rwanda Journal of Medicine and Health Sciences 2022;5(1).\u003c/li\u003e\n\u003cli\u003eTang O, Foti K, Miller III ER, Appel LJ, SP. J. Factors associated with physician recommendation of home blood pressure monitoring and blood pressure in the US population. . American journal of hypertension 2020;33(9):852-9.\u003c/li\u003e\n\u003cli\u003eMaayan-Metzger A, Schushan-Eisen I, Todris L, Etchin A, J. K. Maternal hypotension during elective cesarean section and short-term neonatal outcome. . American journal of obstetrics and gynecology. 2010;202(1):56.e1-e5.\u003c/li\u003e\n\u003cli\u003eTadesse E, Adane M, M. A. Caesarean section deliveries at Tikur Anbessa Teaching Hospital, Ethiopia. . Ethiop J Health Dev 2003;2:37-41.\u003c/li\u003e\n\u003cli\u003eTashfeen k, M.Patel, Hamdi I, IH A-B, A-Y. M. Decision-to-delivery time intervals in emergency caesarean section cases: repeated cross-sectional study from Oman. . Sultan Qaboos University Medical Journa. 2017;27(1).\u003c/li\u003e\n\u003cli\u003eM. S. Effects Of General Versus Spinal Anesthesia Over Apgar Score Of Newborns Delivered By Cesarean Sections And Factors Associated With Apgar Score From January To March 2016 At Gandhi Memorial Hospital, Addis Ababa: . Addis Ababa University. 2016.\u003c/li\u003e\n\u003cli\u003e. !!! INVALID CITATION !!! (3, 4, 13).\u003c/li\u003e\n\u003cli\u003eMercier FJ, Aug\u0026egrave; M, Hoffmann C, Fischer C, A. LG. Maternal hypotension during spinal anesthesia for caesarean delivery. . Minerva Anestesiol. 2013;79(1):62-73.\u003c/li\u003e\n\u003cli\u003eSharma A, Sharma U, P. C. Maternal and Neonatal Outcome in Patients with History of Previous One Cesarean Section. . Indian Medical Gazette 2012.\u003c/li\u003e\n\u003cli\u003eAG. BA. Indications and Outcomes of Emergency Caesarean Section at St Paul\u0026apos;s Hospital Medical College,Addis Ababa, Ethiopia 2017: (Afoul Month Retrospective Cohort Study). Gynecol Reprod Health 2018;2(5):1-12.\u003c/li\u003e\n\u003cli\u003eEdipoglu IS CF, Marangoz EC, GH. O. Effect of anaesthetic technique on neonatal morbidity in emergency caesarean section for foetal distress. PLoS ONE. 2018;13(11).\u003c/li\u003e\n\u003cli\u003eLee JE, George RB, Habib AS. Spinal-induced hypotension: Incidence, mechanisms, prophylaxis, and management: Summarizing 20 years of research. Best Practice \u0026amp; Research Clinical Anaesthesiology. 2017;31(1):57-68.\u003c/li\u003e\n\u003cli\u003eMohammad SI. Effect of General Anesthesia On Apgar Score In Relation To Induction-Delivery and Uterine-Delivery Interval. Tikrit Journal of Pharmaceutical Sciences. 2013;9(1).\u003c/li\u003e\n\u003cli\u003e. !!! INVALID CITATION !!! (3, 5, 23).\u003c/li\u003e\n\u003cli\u003eNyirahabimana N, Ufashingabire CM, Lin Y, Hedt-Gauthier B, Riviello R, J. O. Maternal predictors of neonatal outcomes after emergency cesarean section: a retrospective study in three rural district hospitals in Rwanda. . Maternal Health, Neonatology, and Perinatology. 2017;3(11).\u003c/li\u003e\n\u003cli\u003eBharat Choudhary, Yachana Choudhary, Abhijit P Pakhare, Deonath Mahto, Latha. Early Neonatal Outcome in Caesarean Section: A Developing Country Perspective. Iran journal of pediatrics 2017;27(1).\u003c/li\u003e\n\u003cli\u003eWHO. WHO recommendations on health promotion interventions for maternal and newborn health. https://www whoint/publications/i/item/9789241508742. 2015.\u003c/li\u003e\n\u003cli\u003eElias S, Wolde Z, TantuID T, Gunta M, D. Z. Determinants of early neonatal outcomes after emergency cesarean delivery at Hawassa University comprehensive specialised hospital, Hawassa, Ethiopia. . PLoS ONE 2022;3(2).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"639\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003eTable 1 socio-demographic characteristics of mothers who gave birth through Cesarean section (CS) in WSUCSH, from \u0026nbsp;May to August 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.69170579029734%\" valign=\"bottom\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.630672926447573%\" valign=\"bottom\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"bottom\"\u003e\n \u003cp\u003eFrequency (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"bottom\"\u003e\n \u003cp\u003ePercentages\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.69170579029734%\" valign=\"bottom\"\u003e\n \u003cp\u003eAge of mothers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.630672926447573%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"bottom\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"bottom\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.69170579029734%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.630672926447573%\" valign=\"bottom\"\u003e\n \u003cp\u003e21-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"bottom\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"bottom\"\u003e\n \u003cp\u003e59.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.69170579029734%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.630672926447573%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026gt;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"bottom\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.69170579029734%\" valign=\"bottom\"\u003e\n \u003cp\u003eEducation status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.630672926447573%\" valign=\"bottom\"\u003e\n \u003cp\u003eSecondary and\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"bottom\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"bottom\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.69170579029734%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.630672926447573%\" valign=\"bottom\"\u003e\n \u003cp\u003eAbove\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.69170579029734%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.630672926447573%\" valign=\"bottom\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"bottom\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"bottom\"\u003e\n \u003cp\u003e26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.69170579029734%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.630672926447573%\" valign=\"bottom\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"bottom\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"bottom\"\u003e\n \u003cp\u003e24.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.69170579029734%\" valign=\"bottom\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.630672926447573%\" valign=\"bottom\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"bottom\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"bottom\"\u003e\n \u003cp\u003e41.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.69170579029734%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.630672926447573%\" valign=\"bottom\"\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"bottom\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"bottom\"\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.69170579029734%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.630672926447573%\" valign=\"bottom\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"bottom\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"bottom\"\u003e\n \u003cp\u003e28.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.69170579029734%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.630672926447573%\" valign=\"bottom\"\u003e\n \u003cp\u003eGovernment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"bottom\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"bottom\"\u003e\n \u003cp\u003e17.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.69170579029734%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.630672926447573%\" valign=\"bottom\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.69170579029734%\" valign=\"bottom\"\u003e\n \u003cp\u003eAddress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.630672926447573%\" valign=\"bottom\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"bottom\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"bottom\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.69170579029734%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.630672926447573%\" valign=\"bottom\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"bottom\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"bottom\"\u003e\n \u003cp\u003e52\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\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"639\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003eTable 2 medical and obstetric characteristics of mothers who gave birth through Caesarian section (CS) in WSUCH, from May to August 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003ePercentages\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003eGestation age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003e37-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e76.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026gt;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003eParity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;=3 child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e88.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026gt;3 child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003eBaseline blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003eEstimated blood loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003e500-1000ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e78.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026gt;1000ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e21.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003eProphylactic vasopressor used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e82.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003eDuration of surgery (minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;=45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e47.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026gt;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e52.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003eRoute of utero-tonic drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003eIntravenous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003eadministration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003eIntramuscular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e78.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003eMaternal hypotension after\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e66.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003efifteen minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e33.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003eMaternal hypotension after ten\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e55.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003eMinutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e44.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003eMaternal hypotension after five\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e52.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003eMinute\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e47.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003eMaternal hypotension after one\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e85.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003eMinutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003eMaternal health condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e79.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.27230046948357%\" valign=\"bottom\" style=\"width: 34.1158%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.62284820031299%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"bottom\" style=\"width: 18.3099%;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.794992175273865%\" valign=\"bottom\"\u003e\n \u003cp\u003e20.8\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\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"639\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003eTable 3 the characteristics of neonates at WSUCH, from May to August2023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.7171052631579%\" valign=\"bottom\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.598684210526315%\" valign=\"bottom\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"bottom\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.63157894736842%\" valign=\"bottom\"\u003e\n \u003cp\u003ePercentages\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.7171052631579%\" valign=\"bottom\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.598684210526315%\" valign=\"bottom\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"bottom\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.63157894736842%\" valign=\"bottom\"\u003e\n \u003cp\u003e55.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.7171052631579%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.598684210526315%\" valign=\"bottom\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"bottom\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.63157894736842%\" valign=\"bottom\"\u003e\n \u003cp\u003e44.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.7171052631579%\" valign=\"bottom\"\u003e\n \u003cp\u003eBirth weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.598684210526315%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;2,5KG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"bottom\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.63157894736842%\" valign=\"bottom\"\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.7171052631579%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.598684210526315%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026gt;=2.5-4KG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"bottom\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.63157894736842%\" valign=\"bottom\"\u003e\n \u003cp\u003e76.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.7171052631579%\" valign=\"bottom\"\u003e\n \u003cp\u003ePre-anesthesia heart beat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.598684210526315%\" valign=\"bottom\"\u003e\n \u003cp\u003e80-120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"bottom\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.63157894736842%\" valign=\"bottom\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.7171052631579%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.598684210526315%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"bottom\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.63157894736842%\" valign=\"bottom\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.7171052631579%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.598684210526315%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026gt;120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"bottom\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.63157894736842%\" valign=\"bottom\"\u003e\n \u003cp\u003e25.7\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\u003eTable 4 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Caesarean section, Maternal, Neonatal, Hypotension, unfavorable outcome","lastPublishedDoi":"10.21203/rs.3.rs-4659176/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4659176/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Incidence of maternal hypotension often reported and occurs after caesarian section due to multiple reasons. However, the effect of intraoperative spinal induced hypotension on neonatal adverse outcome during caesarian section hasn't been investigated adequately in Sub-Saharan Countries, including Ethiopia. This study aimed to investigate the effect of intraoperative spinal induced hypotension on neonatal adverse outcome during caesarian section.\u003c/p\u003e\n\u003cp\u003eThe researchers carried out a prospective cohort study from May 15-August 15, 2023. We selected 202 mothers using a convenience sampling method. We collected data by using a structured interviewer administered questionnaire. Once we ensured the collected data's completeness and consistency, we proceeded to enter it into Epidata 4.6. Then, we exported it to SPSS version 25 for analysis. Descriptive statistics were used to summarize data. Binary logistic regression analysis was used to determine the relative risk between neonatal outcome and maternal hypotension and other related features. By using confidence interval and p-value\u0026lt;0.05, the researchers determined the level of significance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult: \u003c/strong\u003eIn this study, a total of 202 participants were given a response rate of 100%. The incidence proportion of adverse early neonatal outcome was 13.4%. Maternal hypotension at 5 minutes ARR maternal health condition (ARR: 3.9, (95%CI: 1.26, 12.2), APGAR score at one minute (ARR: 4.9, (95% CI: 1.7, 14.1)), parity (AOR: 4.2, (95% CI: 1.3, 13.5)), age of the mothers AOR: 5.1, (95% CI: 1.3, 19.5))., and birth weight (AOR: 3.6, (95% CI: 1.18, 10.9)) were identified as predictors of adverse early neonatal outcome.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e In this study, the incidence of adverse neonatal outcome was high. To reduce maternal hypotension after anesthesia, it is necessary to strengthen the monitoring of vital signs. To increase birth interval, it is necessary to expand family planning. Screening during antenatal and Intrapartum period should be promoted to reduce poor maternal health condition, and proper nutrition to reduce birth weight.\u003c/p\u003e","manuscriptTitle":"Impact of Intraoperative Spinal Induced Hypotension on Neonatal Adverse Outcome During Caesarian Section at Wolaita Sodo University Comprehensive Specialized Hospital: 2023, a Prospective Observational Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-23 22:11:33","doi":"10.21203/rs.3.rs-4659176/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b0f2e734-30d7-4e3d-b5aa-c8d5ac81c584","owner":[],"postedDate":"July 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-28T10:14:20+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-23 22:11:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4659176","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4659176","identity":"rs-4659176","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}