Effect of Preoperative Intravenous Fluid Therapy on Maternal Blood Pressure Stability During Spinal Anesthesia for Caesarean Section

Abstract

Cesarean section (CS) is the most frequently performed major surgical procedure worldwide, with rates steadily increasing and stabilizing between 18% and 22% as observed in this study at Zliten Medical Center from 2020 to 2025. Spinal anesthesia remains the preferred technique for these deliveries due to its safety and high success rate, yet it is frequently complicated by maternal hypotension. This cross-sectional study investigated the effect of preoperative intravenous fluid therapy on maternal blood pressure stability among 102 pregnant women undergoing CS under spinal anesthesia in Libya. The participants, primarily aged 30 to 40 years, were monitored for hemodynamic changes and clinical symptoms. Results indicated that while Normal Saline (NS) was the most common fluid used (67.8%), it only provided mid-term stabilization and could not completely prevent an early decline in systolic blood pressure, which dropped to 104 mmHg at 30 minutes post-induction. In contrast, Ringer’s Lactate and Gelofusine showed relatively better recovery speeds. Nausea and vomiting were the most prevalent clinical signs of hypotension, affecting 33.3% of patients, followed by sleepiness and headache. Statistical regression analysis confirmed a significant relationship between both the type and quantity of preoperative fluids and blood pressure stability (p < 0.001). The study concludes that although preoperative fluid loading is fundamental in reducing the severity of spinal anesthesia-induced hypotension, it is insufficient as a standalone preventive measure. Consequently, the research recommends adopting standardized fluid protocols individualized to patient characteristics and combining them with vasopressors to optimize maternal and neonatal safety.