Introduction : Rheumatic mitral stenosis is one of the common cardiac lesion encountered in pregnancy. The hypervolemia and hyperdynamic cardiovascular changes associated with pregnancy cause adverse maternal and foetal outcome, posing multiple challenges.If such a case comes for normal delivery,labour analgesia provides the haemodynamic stability during the stress of labour providing a good neonatal outcome.

An unbooked 30yr old primigravid with severe MS moderate MR and mild TR in CHF presented with labour pains at 39 weeks of gestation.Planned for normal delivery and referred for labour analgesia.Assessed and accepted under ASA grade 3 (risk) . Lumbar epidural cather secured at L2­3 bupivacaine + 2mcg/ml fentanyl/hr started with PCEA. Patient took two bolus doses during labour. Forceps assisted vaginal delivery was done to shorten 2nd stage of labour. Inj.Morphine 2mg i.v, Inj.Lasix 40 mg i.v was given during 2nd stage to prevent worsening of CHF.Vitals stable throughout the process of delivery.

Epidural catheter was kept in situ for 48hrs postpartum to provide analgesia. Conclusion- In a patient with MS, the risk of maternal mortality is greatest during labour and during the immediate postpartum period.In our patient meticulously planned Patient Controlled Epidural Analgesia aided in giving a good outcome. interspace. Bolus of 8ml 0.125% bupivacaine given, Infusion at 6ml of 0.125%

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