Cardiac Complications in Women With Hypertensive Disorders of Pregnancy Undergoing a Cesarean Section: Role of Intraoperative Hemodynamic Monitoring

Introduction Hypertensive disorders of pregnancy (HDP) are major contributors to maternal morbidity and mortality, predisposing to significant cardiac complications during cesarean section. Hemodynamic fluctuations under anesthesia further increase the risk of myocardial ischemia, arrhythmia, and pulmonary edema. Continuous intraoperative monitoring may help identify early hemodynamic instability and improve maternal outcomes. Objective This study aimed to evaluate the frequency, pattern, and predictors of maternal cardiac complications in women with HDP undergoing cesarean section and to determine the protective role of intraoperative hemodynamic monitoring. Methods This retrospective study was conducted at Lady Reading Hospital MTI, Peshawar, Pakistan, over 24 months (January 2023-December 2024). Medical records of 250 women aged 18-45 years with HDP undergoing cesarean section were reviewed. Data included demographic features, disease subtype, anesthesia type, intraoperative hemodynamic parameters, monitoring modality, and postoperative outcomes. Maternal cardiac complications were defined as arrhythmia, pulmonary edema, myocardial ischemia, heart failure, or hemodynamic instability occurring intraoperatively or within 48 hours postoperatively. Data were analyzed using IBM SPSS Statistics for Windows, version 26.0. Independent t-tests and Chi-square tests were applied, and logistic regression identified independent predictors (p < 0.05 considered significant). Results Among 250 women, preeclampsia was the most common subtype (162; 64.8%), followed by eclampsia (48; 19.2%) and gestational hypertension (11.2%). Overall, 54 (21.6%) developed maternal cardiac complications. Advanced maternal age (≥35 years), elevated body mass index (BMI) (≥28 kg/m²), and general anesthesia were independently associated with increased cardiac risk (p < 0.05). Invasive intraoperative hemodynamic monitoring significantly reduced the likelihood of undetected hemodynamic deterioration (adjusted odds ratio (OR) 0.48; 95% confidence interval (CI) 0.25-0.94; p = 0.031). Patients with complications had longer hospital stays and higher ICU admission rates. Conclusion Maternal cardiac complications are common in women with HDP undergoing a cesarean section, especially among older and obese patients and those receiving general anesthesia. Invasive hemodynamic monitoring provides a protective benefit and should be considered in high-risk patients to enhance perioperative safety and improve outcomes.