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INTRODUCTION The increasing prevalence of heart disease in pregnancy is multifactorial and includes hypertension , delayed child bearing ,diabetes and increasing number of women with congenital heart disease now becoming pregnant. AIMS AND OBJECTIVES In US, cardiovascular diseases are responsible for one fourth of all pregnancy related mortalities.Our aim is to create awareness by illustrating this case and the fact that delay in diagnosis and subsequent care may even cause fetal and maternal mortality. MATERIALS AND METHODS ( 80 words) 20 years Primigravida from low middle class socioeconomic background ,at 35+1 weeks of gestation , booked at a private setup , she was admitted through labour room with shortness of breath and cough since 24 weeks of gestation. On examination she felt breathless even at rest .She had 3 antenatal visits and was admitted around one month earlier with the same complaints. She was investigated and treated symptomatically(tablet metoprolol 25 mg once daily) but stopped her treatment against Medical advice. She was admitted again with aggravated symptoms(NYHA 4). RESULTS On examination , she had pedal edema, engorged neck veins , parasternal thrill and continuous machinery murmur present in left infraclavicular region. Her NT Pro BNP was 1152 .Her ECHO reports revelaed large PDA( left to right shunt), LV dysfunction, LVEF ? 35%, dilated LA and LV, ,Mild pulmonary hypertension.She delivered a 1.5 kg baby spontaneously under proper multidisciplinary care. Her postpartum period was uneventful and was followed up by a cardiologist. CONCLUSION Normal pregnancy is associated with changes that place an extra burden on women with heart disease . NT pro BNP levels are correlated with NYHA functional classes .Class I and II are allowed safely, but class III and IV are advised to avoid pregnancy. During labour, presence of senior cardiologist, anesthesiologist and obstetrician is essential,furosemide should be available