الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The technique of choice for cesarean delivery is spinal anaesthesia, not only because it avoids the risks of a general anaesthetia, such as failed intubation and its consequences, but also because it provides better pain control, early ambulation, and thus a faster return to daily activities for new mothers, thereby improving their quality of life.
According to 2014 Egypt Demographic and Health Survey (EDHS), cesarean section rates in Egypt have consistently climbed, reaching 52 percent of all deliveries, marking a more than 100 percent increase since 2005. The rate of institutionalized cesarean section is 67.3 percent; more than double that of Egypt’s regional rivals Jordan and Saudi Arabia. Egypt currently has the world’s third-highest rate of cesarean section, trailing only the Dominican Republic (56.4 percent) and Brazil (55.6 percent).
Side effects of spinal anaesthesia if left untreated, can result in severe morbidity and mortality. Severe hypotension after spinal anaesthesia is a serious consequence that can cause major maternal or foetal compromise if it goes unrecognized or untreated. The most critical in post sympathectomy hypotension especially when associated with bradycardia, is that it can cause cardiac arrest if not treated quickly and effectively. In nonobstetric patients undergoing spinal anaesthesia, the incidence of hypotension and bradycardia has been shown to be 33 and 13%, respectively. While hypotension occurs in up to 60% in obstetric patients.
The main cause of post-spinal anaesthesia (PSA) hypotension is the reduction in sympathetic outflow, which causes arterial vasodilation, decreased venous return, and activation of the Bezold Jarish reflex (BJR). This causes a triad of bradycardia, vasodilation, and hypotension.
The stimulation of 5-HT3 receptors within the intracardiac vagal nerve terminals causes BJR to be elicited.
Some of the methods that are utilized to avoid PSA hypotension are; Leg wrapping, antithromboembolic stockings, volume loading (preload or coload), and vasopressor injection.