Development and Validation of a Prediction Score for Spinal-anesthesia Induced Hypotension in Cesarean Delivery: A prospective cohort study
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Abstract
Objectives: Spinal anesthesia-induced hypotension is the most common complication in cesarean delivery, which can impede uteroplacental blood flow and may deteriorate maternal and fetal welfare. A good predictor for hypotension can help individualized prophylactic treatment. There is currently no simple and good prediction score for spinal hypotension. We conducted a study to develop and internally validate a risk scoring scheme to predict spinal anesthesia-induced hypotension in cesarean delivery.
Materials and Methods: We performed a prognostic clinical prediction model in a prospective cohort design. The parturients who underwent cesarean delivery using spinal anesthesia were included. The outcome was spinal anesthesia-induced hypotension. Predictors included patients’ baseline characteristics, pregnancy details, and preoperative hemodynamic results. Multivariable logistic regression was used for score derivation. Model discrimination and calibration were assessed. The risk score was categorized into low-, moderate-, and high-risk groups.
Results: For 712 parturients who underwent cesarean delivery, a risk score was developed from three predictors: stroke volume index, baseline heart rate, and uterine contraction. The area under the receiver operating characteristic curve was 0.715 (95% confidence interval 0.676-0.754). The risk scores ranged from 0 to 7. When the scores were classified into low- (< 2.5), moderate- (2.5-4.5), and high- (> 4.5) risk groups, the probability of developing hypotension increased from 21.88% in low-risk to 79.95% in the high-risk group.
Conclusion: A risk score developing from stroke volume index, baseline heart rate, and uterine contraction may help predict spinal hypotension in cesarean delivery and guide individualized prophylactic therapy.
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