Parturient with severe mitral stenosis (MS) poorly tolerate pregnancy, while pregnancy is contraindicated in severe Pulmonary artery hypertension (PAH) as it poses high morbidity and mortality due to impending decompensated heart failure, pulmonary edema, atrial fibrillation, thromboembolic events, etc. We successfully managed a case of Rheumatic Heart Disease with severe MS (MVA:0.56 CM2) severe PAH (100mmhg) & severe TR in a 24- yearold multiparous female in active labor for emergency LSCS under General anesthesia despites inadequate NBM of only 2 hours. Aspiration prophylaxis, Modified Rapid Sequence Induction& Intubation, nasogastric tube aspiration, etomidate were key components of induction. Hemodynamic perturbations were promptly managed with fentanyl, loxicard, esmolol. Despites precaution, after adequate reversal and uneventful extubation, she developed pulmonary edema probably due to autoregulation and went for decompensation. Timely management of the critical scenario with 100% O2, furesamide, re-intubation and Noradrenaline improved the hemodynamic status, positive pressure ventilation given for a day and extubated uneventfully in surgical ICU and discharged to ward in a couple of days.