COMPARISON OF PRAM SCALE AND PERFUSION INDEX IN PREDICTING SPINAL ANESTHESIA-INDUCED HYPOTENSION IN CESAREAN SECTION PATIENTS

Abstract

Background:
Spinal anesthesia–induced hypotension is a common complication during cesarean section and is associated with adverse maternal and fetal outcomes. Early prediction is essential for timely intervention. Non-invasive tools such as the Perfusion Index (PI) and the PRAM score have been proposed as predictors, but direct comparative evidence remains limited.

Objective:
To compare the predictive accuracy of baseline Perfusion Index and PRAM score in identifying parturients at risk of developing spinal anesthesia–induced hypotension during cesarean section.

Methods:

This observational cross-sectional study was conducted on 131 parturients undergoing elective cesarean section under spinal anesthesia. Baseline hemodynamic parameters, PRAM score, and Perfusion Index were recorded preoperatively. Hypotension was defined as a decrease in systolic blood pressure to <80% of baseline or <90 mmHg. Diagnostic performance was evaluated using sensitivity, specificity, predictive values, and receiver operating characteristic (ROC) curve analysis.

Results:
Hypotension occurred in 71.5% of patients. A higher baseline Perfusion Index (>3.5) was significantly associated with increased incidence and severity of hypotension (p < 0.001). The Perfusion Index demonstrated sensitivity of 61.7%, specificity of 86.5%, and an area under the curve (AUC) of 0.848, indicating good predictive accuracy. In contrast, the PRAM score showed higher sensitivity (80.9%) but low specificity (29.7%) and poor discriminative ability (AUC = 0.528), with no statistically significant association with hypotension (p = 0.189).

Conclusion:
Baseline Perfusion Index is a more reliable predictor of spinal anesthesia–induced hypotension compared to the PRAM score. Its higher specificity and better discriminative ability make it a valuable tool for early risk stratification in cesarean section under spinal anesthesia.

 Keywords:
Spinal anesthesia, hypotension, cesarean section, perfusion index, PRAM score, obstetric anesthesia, predictive tools