Background <p>Women with congenital heart disease (CHD) often reach childbearing age and may become pregnant. In this study we examine the anesthetic management of cesarean section (C-section) in a&#xa0;university hospital certified for CHD.</p> Methods <p>The anesthesiological care for women with CHD who presented at our certified university hospital between January 2013 and December 2023 was descriptively analyzed. We restricted analysis to women who underwent C‑section (<i>n</i> = 38) and the women were classified according to the complexity of the CHD based on the WHO classification of CHD into I mild (A; <i>n</i> = 6), II moderate (B; <i>n</i> = 13) or III severe (C; <i>n</i> = 19). This study is mainly descriptive and serves as a&#xa0;preliminary study for a&#xa0;larger prospective multicenter study.</p> Results <p>Most of the C‑sections were planned and scheduled (A:&#xa0;<i>n</i> = 3; 50%; B: <i>n</i> = 11; 85% and C: <i>n</i> = 16; 84%) for the dayshift. Anesthesia was performed in more than two thirds of cases by two anesthesiologists. Neuraxial anesthesia was most often performed to achieve adequate surgical tolerance. The frequency of arterial catheter and central venous catheter placements were similar among the groups. Although sometimes introducer sheaths were placed to enable faster introduction of a&#xa0;cannula for extracorporeal membrane oxygenation (ECMO), no use of ECMO was necessary. Postpartum women with severe CHD were more likely to be admitted to the ICU. None of the mothers or newborns died.</p> Conclusion <p>This study aimed to describe the anesthesiological management in women with different severity of CHD undergoing C‑section. This management requires a&#xa0;multidisciplinary approach within a&#xa0;pregnancy heart team. Due to the overall low frequencies and heterogeneity of the CHDs larger multicenter studies are necessary to develop recommendations for obstetric anesthesia in pregnant women with CHD.</p> Graphic abstract <p></p>