Mobitz type II AV block is a potentially serious arrhythmia that can lead to sudden hemodynamic instability. This case describes a 35-year-old patient undergoing cesarean delivery under spinal anesthesia who developed intermittent type II AV block intraoperatively despite no prior cardiac history. She remained asymptomatic and stable, and the arrhythmia resolved without treatment.

Dysrhythmias occur in about 7% of cesarean deliveries under spinal anesthesia, with advanced maternal age as a key risk factor. Spinal anesthesia can reduce sympathetic tone and venous return, while surgical factors and phenylephrine may increase vagal tone, creating autonomic imbalance. In this case, an exaggerated sympathetic blockade likely led to unopposed parasympathetic activity and transient conduction disturbance.

Although rare, these events highlight the importance of close monitoring during neuraxial anesthesia, as well as recognizing when conservative management is appropriate in stable patients.