Managing a pregnant woman with Eisenmenger syndrome is an Obstetric Challenge due to high maternal mortality .A 36 year old G4 known Eisenmenger Syndrome with previous 3 MTPs, was referred to our emergency services at 32+3 weeks of gestation (NYHA IV). She was married at 32years of age and underwent first trimester MTPs 3times. She was divorced due to her medical condition and was re– married a year ago and determined to have child.

Echo showed high muscular VSD measuring 1.6 cms with right to left shunt; RVSP was 50 mm Hg. She was managed in ICUwith continuous Oxygen therapy and Sildanafil 25mg   Furosemide 40 mg once daily.  She had spontaneous preterm precipitate labour on Day3 of admission, an alive preterm male baby of 2.2 kgswas born .She received inj Enoxaparin from 2^nd postnatal day along with continuous Oxygen therapy till 34 th day in ICU.