We describe the case of a 28-week pregnant woman presenting with severe pri
mary pulmonary hypertension (PPH). She had an elective Caesarean section un
der general anaesthesia at 32 weeks gestation. Pulmonary artery pressures (
PAP) measured from a pulmonary artery catheter before anaesthesia were in e
xcess of 100 mm Hg. Intraoperative nitric oxide was used to reduce PAP. Aft
er the delivery of a healthy infant PAP was controlled with nebulized ilopr
ost and a prostacyclin infusion. Seven days later she was discharged from i
ntensive care taking an oral calcium antagonist and warfarin. She developed
intractable right heart failure and died 14 days after delivery. Despite i
ncreasing experience in the use of drugs to reduce PAP, the clinical course
of pregnancy complicated by severe PPH is usually fatal.