The clinical course of pregnancy complicated by severe pulmonary hypertension still carries substantial maternal mortality. Several factors have been implicated as potential risk factors for maternal death, including high pulmonary artery pressure, elevated central venous pressure values, mode of delivery, type and technique of anesthesia, and manner of maternal monitoring. Under normal circumstances, increases in cardiac output in the range of 30 to 50%, blood volume in the range of 40 to 50%, and oxygen consumption of 20% are observed during pregnancy. The pain and valsalva maneuvers associated with labor increase right atrial pressure, BP, and cardiac output. These physiologic events can precipitate the signs and symptoms of pulmonary hypertension, such as dyspnea, cyanosis, hemoptysis, early fatigue, and syncope. Moreover, the large volume shifts at delivery and in the postpartum period place a great demand on the cardiovascular system, magnify the pulmonary resistance leading to right ventricular enlargement and right heart failure, resulting in a high maternal mortality. The reported maternal mortality rates are 36% in association with Eisenmenger syndrome, 30% with primary pulmonary hypertension, and 56% with secondary pulmonary hypertension.