The Effect of Using Hypotension Prediction Index to Reduce Intraoperative Hypotension in Elective Cesarean Sections: A Randomized Controlled Trial

Background and Objectives: The Hypotension Prediction Index (HPI) is a predictive algorithm that enables proactive management of intraoperative hypotension (IOH) and has been integrated into finger cuff devices for practical use in obstetric settings. This study aims to evaluate the effectiveness of HPI in reducing IOH during elective cesarean sections (CS). Materials and Methods: This randomized controlled trial enrolled parturients undergoing elective CS under spinal anesthesia. The parturients were randomized to either the HPI or the control group using non-invasive blood pressure (NIBP) monitoring. The primary outcome was the time-weighted average mean arterial pressure below 65 mmHg (TWA-MAP < 65 mmHg). Secondary outcomes included maternal nausea and vomiting, intraoperative fluid and vasopressor requirements, incidences of hypertension and bradycardia, estimated blood loss, duration of high-dependency unit admission, fetal Apgar scores, umbilical cord pH, and length of neonatal intensive care unit (NICU) stay. Results: A total of 100 parturients were enrolled in the study, with 96 included in the analysis. Baseline demographic characteristics were similar between the groups. The TWA-MAP < 65 mmHg was significantly lower in the HPI group (0.24 [0, 0.70] vs. 1.67 [0.71, 2.57] mmHg; p < 0.001). The incidence of intraoperative and postoperative nausea and vomiting were significantly reduced in the HPI group (p < 0.01). Incidence of intraoperative hypertension and bradycardia, fetal Apgar scores, umbilical cord pH, and length of NICU stay did not differ between the two groups (p > 0.05). Conclusions: HPI-guided management was associated with a reduction in hypotension burden and perioperative nausea and vomiting.