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

Introduction: 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 (ANS) integrity, has demonstrated prognostic value in general surgical populations. However, no previous review has systematically examined whether HRV can serve as a biomarker for tracking autonomic recovery and overall maternal wellbeing during the postpartum period following caesarean delivery. This scoping review will map the extent, range, and nature of evidence on HRV monitoring in caesarean populations within a recovery-assessment framework. Review question: What is the nature, extent, and distribution of published evidence on the use of heart rate variability for evaluating autonomic recovery and maternal wellbeing after caesarean delivery? Inclusion criteria: The review follows a Population–Concept–Context (PCC) framework (Table 1). The population comprises women undergoing caesarean delivery, with elective procedures as the primary focus and emergency caesarean analysed as a distinct subgroup. The concept is any validated measurement of HRV parameters, including time-domain, frequency-domain, and non-linear indices. The context encompasses the perioperative-to-postpartum continuum, from the preoperative baseline through six weeks after delivery. Original peer-reviewed research of any observational or interventional design will be eligible; conference abstracts, dissertations, and non-English publications will be excluded. Methods: The protocol adheres to the Joanna Briggs Institute (JBI) methodology for scoping reviews, with reporting guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A three-step search strategy will be employed across PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and Web of Science, followed by hand-searching of reference lists and citation tracking. Two independent reviewers will perform screening and data extraction using a piloted extraction form. Findings will be synthesised narratively and presented through temporal evidence mapping, an evidence gap map, and structured summary tables. Discussion: By identifying methodological inconsistencies and evidence gaps, this review will establish a foundation for future studies investigating HRV-guided enhanced recovery after caesarean (ERAC) protocols and inform the design of targeted randomised controlled trials.