Objective: To observe hemodynamic change in cesarean section for pregnant women with heart disease and pulmonary hypertension and analyze related risk factors to heart failure during and after the surgery. Methods: Prospective observational study on clinical data of 140 cases of pregnant women with cardio disease and pulmonary hypertension in cesarean section in obstetrics and gynecology was conducted in Beijing Anzhen Hospital from October 2012 and October 2017 to analyze hemodynamic change in peri-operative period. These enrolled patients were performed spinal anesthesia elective cardiac capacity monitoring. In addition, single factor analysis and logistic regression analysis of multi factors were adopted to analyze dangerous factors to heart failure during and after the surgery. Results: Firstly, compared with the basic blood pressure upon entering the room, blood oxygen (P=0.031) and blood pressure (systolic pressure (SBP), P=0.012; diastolic pressure (DBP), P=0.018) before anesthesia for the patient were reduced. Blood pressure (SBP, P=0.000; DBP, P=0.026) and systemic vascular resistance were reduced (P=0.015) three minutes after narcotized medication compared with that before anesthesia. Blood pressure (SBP, P=0.000; DBP, P=0.000), blood oxygen (P=0.015) and systemic vascular resistance (P=0.000) were all reduced three minutes after narcotized medication compared with that before delivery of the baby, but cardiac output (P=0.041) and heart rate (P=0.000) were increased. Blood pressure (P=0.036, P=0.039), systemic vascular resistance (P=0.029) and blood oxygen (P=0.039) of the patient were all increased and other indexes gradually and slowly recovered to the level before delivery of the baby. But heart rate of the patient was still relatively fast (P=0.046). Secondly, 15 cases were subject to heart failure among 140 cases in the data and the ratio was 10.7%. Analysis of single factors and multi factors showed hypoproteinemia (P=0.008, OR=2.015), increase of blood plasma brain natriuretic peptide (BNP) (P=0.024, OR=2.485), anemia (P=0.002, OR=2.484), reduction ejection fraction (P=0.019, OR=1.752), heart structure change (P=0.005, OR=5.012), cardiac function above III grade (P=0.000, OR=261.174), moderate-severe pulmonary hypertension (P=0.003, OR=4.912), rheumatic heart disease (P=0.039, OR=3.156) and systolic time interval (P=0.018, OR=20.228) are independent dangerous factors of heart failure. Conclusion: Hemodynamic change for pregnant women in peri-operative period is obvious and closely monitoring is needed. Moreover, heart failure risk of pregnant women with heart disease and pulmonary hypertension is related to hypoproteinemia, increase of blood plasma BNP, anemia, reduction of ejection fraction, heart structure change, cardiac function above III grade, moderate-severe pulmonary hypertension, rheumatic heart disease and systolic time interval.