Heart rate variability as a biomarker for autonomic recovery and maternal wellbeing following caesarean delivery: a scoping review protocol.

Abstract

Caesarean delivery accounts for more than 21% of all births worldwide, with rates exceeding 30% in several countries, yet objective physiological markers for monitoring postoperative maternal recovery remain scarce. Heart rate variability (HRV), a non-invasive index of autonomic nervous system integrity, has demonstrated prognostic value in general surgical populations. This scoping review will map the extent, range and nature of evidence on HRV monitoring in caesarean populations within a recovery-assessment framework. The review follows a Population-Concept-Context framework. The primary population comprises women undergoing elective caesarean delivery, with emergency procedures analysed as a distinct subgroup. The concept covers any validated measurement of HRV parameters (time-domain, frequency-domain and non-linear indices). The context spans the perioperative-to-postpartum continuum, from preoperative baseline through 6 weeks after delivery. Adhering to the Joanna Briggs Institute methodology, we will employ a three-step search strategy across PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials and Web of Science. Two independent reviewers will screen records and extract data. Findings will be synthesised narratively and presented via temporal evidence mapping, an evidence gap map, and structured summary tables. Formal ethics approval is not required because this review exclusively analyses published data. We will disseminate our findings through publication in a peer-reviewed journal and presentations at relevant academic conferences.