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Introduction: Unrepaired COA is a relatively rare lesion where aorta is abnormally narrowed. As per World Health Organisation, severe coarctation should preclude pregnancy, warranting pregnancy interruption. Almost 5% women have maternal complications (cerebral infarction, aortic dissection, aortic rupture, hypertensive crisis, and bacterial endocarditis) and foetal complications (premature birth with placental ischemia/abruption). Objective: Patient presented with maternofoetal distress having COA NYHA Grade 4 treated with immediate caesarean section (favourable outcome) to reduce significant perfusion risk for foetus. Case Summary: 28-year-old G3P1L1A1 with 35.3 weeks with previous CS came to Emergency with c/o shortness of breath and decreased foetal movement. Vitals: BP: (Right arm) 156/90 mmHg & (Left arm) 140/84 mmHg, Pulse: 140 bpm, SpO2: 74% (95% with supplemental oxygen), Urinary Dipstick: 2+ General Physical Examination: Pedal oedema. Cardiac Examination: dyspnoea with systolic murmur Obstetric Examination: P/A: Ut 36-38 weeks cephalic. Scar tenderness absent P/V: Poor Bishop?s score. Non stress Test (NST) was non-reactive & informed high-risk consent was taken. Multidisciplinary team of obstetricians, cardiologist and anaesthesiologist was involved. Blood samples were sent. Bedside ECG & 2D ECHO revealed ejection fraction = 68% and peak gradient of 84 mmHg distal to the left subclavian artery. No regional wall motion abnormalities (RWMA); Left ventricular hypertrophy (LVH) present. Decision for immediate c-section taken due to foetal distress & severe pre-eclampsia. Anaesthesia Protocol: General Anaesthesia administered. Postoperative Management: Continuous nitroglycerin infusion started for BP stabilization in Critical Care Unit. Derangements in CBC, LFT and KFT were managed conservatively. Discharge plan included advising a CT aortogram for stenting. Conclusion: This case underscores the importance of a multidisciplinary approach for correct diagnosis and timely intervention for favourable fetomaternal outcome. Resection of COA must be undertaken to protect against possibility of a dissecting aneurysm and further rupture.