INTRODUCTION : Maternal heart disease complicates 0.2 to 3% of pregnancies of which rheumatic heart disease is a common cause. The unique physiological changes in pregnancy along with pathological changes associated with valvular lesions in rheumatic heart disease further complicate the anaesthetic management.

CASE PRESENTATION : A 26 year lady Gravida 2 Para 1 Live 1 with 33weeks of gestational age diagnosed with severe aortic regurgitation and mild aortic stenosis ; moderate mitral regurgitation and moderate mitral stenosis ; mild tricuspid regurgitation and mild pulmonary arterial hypertension of rheumatic origin; which was confirmed 2D Echocardiography. She was on tab. Digoxin 0.25mg once a day for 5 times a week ; tab. Furosemide 10 mg twice a day. Patient was posted for emergency cesaerian section. Patient monitored with pulse oximetry, ECG, NIBP monitoring. Patient was given graded epidural blockade. Intraoperatively and postoperatively haemodynamic stability was maintained and adequate postoperative analgesia was provided.