{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T18:09:30Z","timestamp":1785780570174,"version":"3.56.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T00:00:00Z","timestamp":1750204800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>This study aimed to investigate the impact of maternal type and its interactions on the incidence of hypotension following spinal anesthesia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this retrospective cohort study, both primiparous and multiparous women were included. Demographic, pregnancy-related, and hemodynamic data were collected. Univariate and multivariate logistic regression analyses were performed to evaluate the association between these factors and the occurrence of hypotension after spinal anesthesia. Additionally, multivariate models with and without maternal type were constructed, followed by interaction analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Primiparous women had a lower median age and slightly greater weight gain during pregnancy compared to multiparous women. They also exhibited significantly higher pleth variability index (PVI) and heart rate (HR), while heart rate variability (HRV) was significantly lower. Univariate regression analysis identified maternal type, age, weight gain during pregnancy, estimated fetal weight, PVI, HR, HRV, and systolic blood pressure (SBP) as significant predictors of hypotension. Multivariate model analysis showed that adding the variable of parity significantly improved the model\u2019s ability to discriminate the occurrence of hypotension (Model 2 AUC\u2009=\u20090.815 vs. Model 1 AUC\u2009=\u20090.740). Interaction analysis revealed significant interactions between heart rate variability (HRV), systolic blood pressure (SBP), gestational weight gain, and parity, suggesting that these physiological characteristics are more strongly associated with hypotension in primiparas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>In conclusion, primiparous women are at significantly higher risk of developing hypotension after spinal anesthesia than multiparous women. Baseline perfusion index (PI), estimated fetal weight, and baseline PVI are key contributing factors to this outcome.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1617342","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T05:47:41Z","timestamp":1750225661000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Analysis of the risk difference in post-spinal anesthesia hypotension between primiparas and multiparas in cesarean section"],"prefix":"10.3389","volume":"12","author":[{"given":"Jizheng","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinli","family":"Che","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohua","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanlu","family":"Ren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000521364","article-title":"Spinal anesthesia versus general anesthesia in gynecological laparoscopic surgery: a systematic review and meta-analysis","volume":"87","author":"Della Corte","year":"2022","journal-title":"Gynecol Obstet Invest"},{"key":"B2","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1016\/j.ajog.2020.08.105","article-title":"Spinal anesthesia-induced hypotension: is it more than just a pesky nuisance?","volume":"223","author":"Wong","year":"2020","journal-title":"Am J Obstet Gynecol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"90","DOI":"10.20471\/acc.2019.58.s1.13","article-title":"Spinal anaesthesia-induced hypotension in obstetrics: prevention and therapy","volume":"58","author":"\u0160klebar","year":"2019","journal-title":"Acta Clin Croat"},{"key":"B4","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1093\/bja\/66.5.596","article-title":"Spinal anaesthesia in obstetrics","volume":"66","author":"Kestin","year":"1991","journal-title":"Br J Anaesth"},{"key":"B5","first-page":"540","article-title":"Hypotension associated with spinal anaesthesia for caesarean section","volume":"83","author":"Rocke","year":"1993","journal-title":"S Afr Med J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1097\/00000542-199302000-00036","article-title":"Hypotension and spinal anesthesia","volume":"78","author":"Szmuk","year":"1993","journal-title":"Anesthesiology"},{"key":"B7","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1007\/s00404-017-4641-0","article-title":"Hypotension due to spinal anesthesia influences fetal circulation in primary caesarean sections","volume":"297","author":"Lato","year":"2018","journal-title":"Arch Gynecol Obstet"},{"key":"B8","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1111\/aas.13012","article-title":"Pleth variability index can predict spinal anaesthesia-induced hypotension in patients undergoing caesarean delivery","volume":"62","author":"Kuwata","year":"2018","journal-title":"Acta Anaesthesiol Scand"},{"key":"B9","doi-asserted-by":"publisher","first-page":"103175","DOI":"10.1016\/j.ijoa.2021.103175","article-title":"Prediction of spinal anesthesia-induced hypotension during elective cesarean section: a systematic review of prospective observational studies","volume":"47","author":"Yu","year":"2021","journal-title":"Int J Obstet Anesth"},{"key":"B10","doi-asserted-by":"publisher","first-page":"294","DOI":"10.4103\/joacp.JOACP_385_20","article-title":"A study to evaluate perfusion index as a predictor of hypotension following spinal anesthesia for caesarean section","volume":"38","author":"Lal","year":"2022","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"23","DOI":"10.4103\/sja.sja_378_23","article-title":"The diagnostic accuracy of preoperative perfusion index as a predictor of postspinal anesthesia hypotension in parturients undergoing cesarean delivery: a prospective non-blinded observational study","volume":"18","author":"Kesavankutty","year":"2024","journal-title":"Saudi J Anaesth"},{"key":"B12","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1007\/s00586-023-08071-y","article-title":"Comparative outcomes of awake spine surgery under spinal versus general anesthesia: a comprehensive systematic review and meta-analysis","volume":"33","author":"Rajjoub","year":"2024","journal-title":"Eur Spine J"},{"key":"B13","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1002\/ijgo.13563","article-title":"Transversus abdominis plane block versus wound infiltration for post-cesarean section analgesia: a systematic review and meta-analysis of randomized controlled trials","volume":"153","author":"Riemma","year":"2021","journal-title":"Int J Gynaecol Obstet"},{"key":"B14","doi-asserted-by":"publisher","first-page":"2786","DOI":"10.26355\/eurrev_202304_31909","article-title":"The effect of TAP block use in postoperative analgesic in cesarean section","volume":"27","author":"Erol","year":"2023","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"B15","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1080\/14767058.2017.1280020","article-title":"First-trimester placental vascular development in multiparous women differs from that in nulliparous women","volume":"31","author":"Ballering","year":"2018","journal-title":"J Matern Fetal Neonatal Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1038\/ajh.2012.57","article-title":"Hemodynamic adaptations in different trimesters among nulliparous and multiparous pregnant women; the generation R study","volume":"25","author":"Rurangirwa","year":"2012","journal-title":"Am J Hypertens"},{"key":"B17","doi-asserted-by":"publisher","first-page":"111236","DOI":"10.1016\/j.jclinane.2023.111236","article-title":"Pleth variability index during preoxygenation could predict anesthesia-induced hypotension: a prospective, observational study","volume":"90","author":"Kim","year":"2023","journal-title":"J Clin Anesth"},{"key":"B18","doi-asserted-by":"publisher","first-page":"100964","DOI":"10.1016\/j.accpm.2021.100964","article-title":"Perfusion index: physical principles, physiological meanings and clinical implications in anaesthesia and critical care","volume":"40","author":"Coutrot","year":"2021","journal-title":"Anaesth Crit Care Pain Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"671","DOI":"10.23736\/s0375-9393.23.17065-9","article-title":"Perfusion index for early identification of regional anesthesia effectiveness: a narrative review","volume":"89","author":"Chu","year":"2023","journal-title":"Minerva Anestesiol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1111\/j.1469-8986.1997.tb02140.x","article-title":"Heart rate variability: origins, methods, and interpretive caveats","volume":"34","author":"Berntson","year":"1997","journal-title":"Psychophysiology"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.1097\/00000542-200506000-00005","article-title":"Heart rate variability predicts severe hypotension after spinal anesthesia for elective cesarean delivery","volume":"102","author":"Hanss","year":"2005","journal-title":"Anesthesiology"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.1111\/j.1365-2044.2011.06873.x","article-title":"Effect of weight gain during pregnancy on heart rate variability and hypotension during caesarean section under spinal anaesthesia","volume":"66","author":"Ghabach","year":"2011","journal-title":"Anaesthesia"},{"key":"B23","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.ijoa.2020.11.010","article-title":"Selection of baseline blood pressure to guide management of hypotension during spinal anaesthesia for caesarean section","volume":"45","author":"Luther","year":"2021","journal-title":"Int J Obstet Anesth"},{"key":"B24","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1097\/jcma.0000000000001056","article-title":"Risk factors of more severe hypotension after spinal anesthesia for cesarean section","volume":"87","author":"Li","year":"2024","journal-title":"J Chin Med Assoc"},{"key":"B25","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.autneu.2017.05.002","article-title":"Autonomic dysreflexia after spinal cord injury: systemic pathophysiology and methods of management","volume":"209","author":"Eldahan","year":"2018","journal-title":"Auton Neurosci"},{"key":"B26","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1097\/aco.0000000000001001","article-title":"Management of maternal COVID-19: considerations for anesthesiologists","volume":"34","author":"Bernstein","year":"2021","journal-title":"Curr Opin Anaesthesiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"22","DOI":"10.3390\/jcm11226868","article-title":"Sufentanil vs. dexmedetomidine as neuraxial adjuvants in cesarean section: a mono-centric retrospective comparative study","volume":"11","author":"Coviello","year":"2022","journal-title":"J Clin Med"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1617342\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T05:47:42Z","timestamp":1750225662000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1617342\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,18]]},"references-count":27,"alternative-id":["10.3389\/fsurg.2025.1617342"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2025.1617342","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,18]]},"article-number":"1617342"}}