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Background and Aims The prevalence of cardiac abnormality during pregnancy was estimated at around 1–4%, and it will keep increasing along with the advancement of technologies, allowing women with cardiac abnormalities to reach reproductive age. Anesthesia management for C-section patients with cardiac abnormalities serves as a challenge; physiological changes during pregnancy might cause perioperative deterioration in heart condition and hemodynamic instability. For cesarean sections, spinal anesthesia is the most often used approach. Therefore, choosing an appropriate anesthesia technique was crucial for optimal maternal and neonatal outcome.Methods An observational retrospective study was conducted on 36 pregnant women who underwent C-sections. The data is then analyzed using descriptive analysis and cross-tabulation to find patterns between variables.Results The average age was 27,78±5,9 years old (range of 18–45 years old). Distribution of ASA Physical Status was mostly ASA 3 (77.8%), followed by ASA 4 (22.2%). Pulmonary hypertension (PH) was the most prevalent cardiac abnormality (50.0%). Ventricular Septal Defect (VSD) was the most prevalent (22.2%) septal defect. The most prevalent combination of coexisting cardiac abnormalities was PH+TR (11.1%) and was followed by ASD+PH+TR (8.3%). The most used anesthesia technique was low-dose spinal anesthesia using Bupivacaine heavy 0,5% 7.5 mg, combined with epidural (CSE) (61.1%). Patients with PH, VSD, and RHD mostly undergo CSE, respectively 66.7%, 75.0%, and 100% of the total for each case. Only 3 patients (8.3%) experienced problems during the operation. All patients (100%) need post-operative ICU treatment, and all patients (100%) were discharged in stable condition despite the high-risk nature of this population.Conclusions Low-dose spinal anesthesia provides adequate surgical anesthesia. These results emphasize the importance of appropriate selection of anesthesia techniques suited to the type of cardiac abnormalities, comprehensive perioperative evaluation, and adequate postoperative care to optimize outcomes in this high-risk population. Further studies with a larger sample size and long-term outcome evaluation are needed.