Association of Pre-Eclampsia with Intraoperative Hemodynamics and Postoperative Complications in Cesarean Delivery Under General Anesthesia: A Retrospective Cohort Study

<b>Background:</b> Pre-eclampsia causes endothelial dysfunction and altered vascular reactivity, which may increase perioperative risk, particularly under the physiologic stress of general anesthesia (GA). However, the evidence regarding its independent effects under uniform GA conditions is limited. This study assessed the association between pre-eclampsia and intraoperative hemodynamic stability as well as postoperative complications in women undergoing cesarean section under GA. <b>Methods:</b> This retrospective cohort study screened 1242 women who underwent GA for cesarean delivery between January 2017 and July 2024. After applying exclusion criteria, 959 patients were included: 169 with and 790 without pre-eclampsia. The intraoperative blood-pressure and heart-rate trends, vasopressor use, operative variables, and postoperative complications were analyzed. Predictors of postoperative respiratory complications were identified using logistic regression with Firth correction. <b>Results:</b> Patients with pre-eclampsia showed consistently higher mean arterial pressures throughout induction and emergence, whereas trends in heart rate were similar. Postoperative morbidity was higher in the pre-eclampsia group (11.8% vs. 5.3%), with increased respiratory complications (3.6% vs. 1.1%) and longer hospital stays. Pre-eclampsia independently predicted postoperative respiratory complications in univariable (odds ratio [OR] 3.27, 95% confidence interval [CI] 1.13-8.90, <i>p</i> = 0.03), multivariable (OR 3.13, 95% CI 1.09-8.98, <i>p</i> = 0.03), and Firth's analyses (OR 3.21, 95% CI 1.11-8.77, <i>p</i> = 0.03). <b>Conclusions:</b> Pre-eclampsia was associated with persistent intraoperative hypertension and higher risks of postoperative respiratory morbidity under GA. These findings support the need for individualized hemodynamic control, cautious fluid management, and increased postoperative respiratory surveillance in patients with pre-eclampsia.