Association between intra-abdominal pressure and post-spinal hypotension during cesarean delivery: a prospective...

Post-spinal hypotension remains a common challenge during cesarean delivery. This prospective study investigated the association between preanesthetic intra-abdominal pressure (IAP) and the risk of this complication.

A total of 83 parturients undergoing elective cesarean delivery under spinal anesthesia were included. IAP was measured before anesthesia. The primary analysis used Poisson regression with robust standard errors to assess the association, reporting risk ratios for a clinically relevant 5-mmHg increase in IAP. A parsimonious model adjusted for body mass index (BMI) was used to ensure robustness. An exploratory receiver operating characteristic analysis with bootstrap internal validation was performed to describe the pressure's discriminatory performance.

In the primary multivariable model, each 5-mmHg increase in IAP was associated with an approximately 3-fold higher risk of hypotension (adjusted relative risk (RR) = 2.88, 95% CI: 2.00-4.15, p < 0.001). Exploratory receiver operating characteristic (ROC) analysis yielded an area under the curve of 0.92; bootstrap validation indicated a corrected estimate of 0.919, and that a data-driven IAP cutoff was unstable, ranging from 12.5 to 13.5 mmHg. Using this exploratory threshold (≥12.5 mmHg), the unadjusted RR for hypotension was 7.79 (95% CI: 3.36-22.61).

Higher baseline IAP is significantly associated with an increased risk of post-spinal hypotension during cesarean delivery. The association is robust when considering maternal body size. While an IAP threshold of approximately 12-14 mmHg may help identify parturients at greater risk, this finding is exploratory and requires external validation.