Background: Sever pre-eclampsia is defined as a disorder that occurs in pregnancy which manifests as hypertension and proteinuria with at least one maternal organ dysfunction involvement. Objectives: To determine how pre-eclampsia affects maternal hemodynamics during cesarean delivery after spinal anesthesia. Patients and Methods: This prospective randomized study was carried out on 30 normotensive females and 30 pre-eclamptic females admitted to Hospital for elective cesarean section using spinal anesthesia. The study was conducted in the Obstetrics Department of Al-Azhar University Hospitals, from January 2019 till December 2019. Results: Incidence of hypotension after spinal anesthesia in group A (normotensive) was 66.7% and in group B (preeclampsia) was 30%. The total dose of Ephedrine required to correct hypotension when it happen mean dose ± SD in group A was 9.83 ± 9.30 and in group B was 3.00 ± 5.15. Neonatal outcomes (APGAR score and umbilical artery blood gases) were comparable. There was increased incidence of headache and blurring of vision among severe preeclampsia parturient. Conclusion: Incidence of hypotension after spinal anaesthesiawas less frequent and less severe in preeclampsia patients and required lower dose of ephedrine than normotensive population. There was increased incidence of headache and blurring of vision among severe preeclampsia parturient. No difference in neonatal outcome between normotensive and severe preeclampsia population following spinal anesthesia.