Background:Pre-eclampsia is a multisystem disorder of pregnancy associated with significant maternal and fetal morbidity. Cardiovascular complications are a major cause of morbidity, and their early prediction remains crucial. Electrocardiography (ECG) offers a simple and non-invasive method to detect early cardiac changes.Aim:To assess electrocardiographic abnormalities in women with pre-eclampsia and evaluate their predictive value for cardiovascular complications.Material and Methods:This hospital-based, prospective observational study was conducted in the Department of Obstetrics and Gynecology in collaboration with the Department of Cardiology at a tertiary care teaching hospital. A total of 90 pregnant women diagnosed with pre-eclampsia were consecutively enrolled. Detailed clinical evaluation, blood pressure measurement, and resting 12-lead ECGs were performed. ECG parameters including heart rate, PR interval, QRS duration, QTc interval, P-wave dispersion, T-wave inversions, ST-segment changes, and arrhythmias were assessed. Participants were monitored throughout hospitalization and up to six weeks postpartum for cardiovascular complications such as pulmonary edema, arrhythmias, cardiac arrest, myocardial infarction, heart failure, and stroke. Results:The mean age of participants was 28.60 ± 5.10 years, and mean gestational age was 34.20 ± 2.80 weeks. T-wave inversions were noted in 22.22%, ST-segment changes in 17.78%, and arrhythmias in 15.56% of participants. Prolonged QTc intervals were observed in 20.00% of cases. Cardiovascular complications included acute pulmonary edema (8.89%), new-onset arrhythmias (11.11%), heart failure (6.67%), myocardial infarction (3.33%), and stroke (2.22%). Prolonged QTc interval, T-wave inversions, ST-segment changes, and presence of arrhythmias were significantly associated with the occurrence of cardiovascular complications (p<0.001).Conclusion:Pre-eclampsia is associated with significant electrocardiographic abnormalities that can predict the risk of cardiovascular complications. Routine ECG screening in pre-eclamptic women may facilitate early detection of high-risk cases, allowing timely interventions to improve maternal outcomes.