Hemodynamic Changes During Cesarean Section Under Spinal Anesthesia in Normotensive and Hypertensive Pregnant Women—A Narrative Review

Data on cardiac and hemodynamic parameters associated with preeclampsia (PE), particularly changes occurring in the immediate perioperative period, remain scarce. These changes are clinically important for the management of patients with severe PE or underlying cardiac dysfunction. Maternal hemodynamics undergo substantial alterations during cesarean section (CS) as a result of sympathetic blockade induced by spinal anesthesia, the vasodilatory effects of general anesthetics, and changes in blood flow related to aortocaval compression in the supine position and during delivery. Massive hemorrhage represents an additional factor contributing to these alterations. In routine clinical practice, maternal heart rate (HR) and blood pressure (BP) are monitored to assess circulatory status. However, a more precise evaluation can be achieved by measuring stroke volume (SV), cardiac output (CO), and systemic vascular resistance (SVR). These parameters are particularly relevant in cases of severe hemorrhage or hypertension, as they may facilitate targeted hemodynamic management. Overall, hemodynamic responses to cesarean delivery under spinal anesthesia appear to differ between normotensive and hypertensive pregnancies. Normotensive parturients seem to be more susceptible to pronounced hypotension following sympathetic blockade, whereas hypertensive disorders of pregnancy are associated with altered vascular reactivity and modified intraoperative hemodynamic responses. Nevertheless, interpretation of these findings remains limited by the heterogeneity of the available studies and the lack of quantitative evidence synthesis.