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INTRODUCTION: Spinal anesthesia is a commonly modality used for caesarean sections and is associated with hypotension in many cases leading to increased morbidity. Postpartum hemorrhage is also increased in the case of hypotension and so as in cases of high risk pregnancy. Beforehand prediction of these factors can help in decreasing the rate of complications. plethysmography waveforms can help in effective assessment of perfusion dynamics and vascular tone. It is sensitive to change in vascular tone, gives insight into nature of cardiovascular changes and hence the management. AIMS AND OBJECTIVES This study aimed to evaluate the role of pulse plethysmograph in the prediction of hypotension and on table postpartum hemorrhage by the assessment of perfusion hemodynamics and its management accordingly. MATERIAL AND METODS : This observational study was conducted on 200 patients who were undergoing emergency or elective caesarean section. Out of these 100 women were taken as control, who had no known high risk factors and 100 were taken as cases with high risk factors. Spinal anesthesia was given using a 25 or 26-gauge spinal needle with bupivacaine at L3-4 interspinous space. Pre and post-anesthesia observations done on multipara monitor- plethysmograph, ECG readings, non-invasive blood pressure in another arm, heart rate and other complaints like giddiness or uneasiness,headache,chest pain, nausea-vomiting were recorded. RESULTS: Pre and post-spinal changes in blood pressure was observed. Fall in blood pressure was observed in both the groups . Post spinal anesthesia minor fall in systolic blood pressure (SBP) was observed in 21 patients, moderate fall in 29 patients, severe fall in 12 patients in control group and in study group- mild in 29 , moderate in 37 and a massive fall in 17 patients. A significant difference was observed between mean pre- and post-spinal anesthesia SBP (P<0.001) in both the groups. Significant association was observed between grades of SBP and width of PPG (P<0.05). Receiver operating characteristic curve showed the changes in contour and dicrotic notch variations in pulse plethysmograph was good for prediction of hypotension in both the groups. CONCLUSIONS: Readings of the pulse plethysmograph gives a good prediction of hypotension with assessment of perfusion dynamics and vascular tone and hence can be a useful tool to guide the management accordingly.