Undiagnosed cyanotic heart disease - A challenge to emergency medical professionals

Cyanotic heart disease characterized by pulmonary hypertension with reversal or bidirectional shunt associated with atrioventricular septal defects or patent ductus arteriosus is known as Eisenmenger syndrome. Pregnancy-associated decreased systemic vascular resistance increases the degree of right to left shunting and hypoxemia, thereby increasing substantially both the maternal mortality and fetal wastage which is reported to be as high as 70%. Ideally, this is a contraindication for conceiving but if there is strong desire of pregnancy, it should be a supervised antenatally by multidisciplinary team. We present a case of a young primigravida who had cesarean delivery under subarachnoid block at 37 weeks of gestation and was referred after fall in oxygen saturation. It can be a challenge to manage these cases at a peripheral unit if the condition is undiagnosed.