Assessment of perioperative hemodynamic changes following spinal anesthesia in patients undergoing surgery for ruptured ectopic pregnancy

Abstract

Background: Ruptured ectopic pregnancy requires urgent surgical intervention, and sympathetic blockade following spinal anaesthesia may exacerbate haemodynamic instability in patients with significant blood loss. Objective was to assess perioperative hemodynamic changes and factors associated with hypotension following spinal anesthesia in patients undergoing surgery for ruptured ectopic pregnancy.

Methods: This prospective observational study enrolled 46 women undergoing emergency surgery under spinal anaesthesia at Addin Momin Medical College and Hospital over 12 months (January 2015-February 2026). Heart rate (HR), systolic and diastolic blood pressure (SBP, DBP), mean arterial pressure (MAP), and oxygen saturation (SpO₂) were monitored perioperatively. Repeated-measures ANOVA and binary logistic regression were used for statistical analysis.

Results: The mean age was 27.4±5.2 years. HR, SBP, DBP, and MAP declined significantly following spinal anaesthesia (all p<0.001), with SBP decreasing from 108.4 to 92.1 mmHg and MAP from 80.9 to 68.1 mmHg at 10 minutes. SpO₂ remained stable (p=0.324). Hypotension occurred in 37.0% of patients and bradycardia in 10.9%; 37.0% received ephedrine and 60.9% required blood transfusion. Estimated blood loss >1000 ml (OR=3.56, p=0.008), preoperative hemoglobin <9 gm/dl (OR=2.84, p=0.021), and ASA III status (OR=2.31, p=0.047) were significant predictors of hypotension.

Conclusions: Spinal anesthesia was associated with significant perioperative hemodynamic changes, particularly hypotension. Adequate resuscitation, careful monitoring, and prompt management are essential to optimise patient outcomes.