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

Background: Hypotension is the most common and significant complication of spinal anesthesia during cesarean section, often resulting in maternal discomfort and reduced uteroplacental perfusion, which may compromise fetal well-being. Conventional spinal anesthesia (CSA) is widely used in Sudan but is associated with high rates of hypotension. Segmental spinal anesthesia (SSA), which targets a more restricted dermatomal block, has been proposed as a technique that may offer improved hemodynamic stability. However, evidence comparing both techniques in Sudanese obstetric practice is limited. Objective: To compare the incidence and severity of hypotension in obstetric patients undergoing cesarean section under CSA versus SSA at Kassala Al-Saudi Maternity Hospital. Methods: A prospective, observational hospital-based study was conducted from July to December 2025, including 120 obstetric patients aged 18–40 years (ASA II). Total coverage sampling was used. Patients received either CSA with 12.5 mg hyperbaric bupivacaine at L3–L5 or SSA with 8 mg hyperbaric bupivacaine at T10–T11. Hemodynamic parameters were recorded at baseline and every three minutes intraoperatively. Incidence, severity, timing, and frequency of hypotension, along with vasopressor requirements, were compared using SPSS version 26. Statistical significance was set at p < 0.05. Results: CSA resulted in a higher incidence of hypotension, with more moderate and severe cases compared to SSA (p = 0.001). Lowest SBP and DBP values were significantly lower in CSA (p = 0.004 and p = 0.002). Hypotension occurred earlier and more frequently in CSA (p = 0.000, p = 0.013). Vasopressor use and total ephedrine dose were significantly higher in CSA (p = 0.000, p = 0.034). Conclusion: SSA demonstrated superior hemodynamic stability with fewer and less severe hypotensive episodes and reduced vasopressor requirements. SSA may offer a safer alternative to CSA in obstetric anesthesia when performed by trained anesthetists.