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Complete heart block with pacemaker implantation is rare in pregnancy. Most patients remain asymptomatic and only very few need pacemaker implantation which is usually removed postnatally after the cardiac output returns to normal prepregnant state, but not so in this case. This 28yr old  Primigravida with 38weeks of gestation was admitted with draining pervaginum. She is a known case of severe  Rheumatic mitral stenosis who underwent mitral valve   replacement 3yrs back. On admission she was diagnosed with complete heart block. She underwent temporary             pacemaker implantation following which emergency                 caesarean section for Nonprogression of labour due to           deflexed head. The surgery was uneventful. Baby had               ecchymosis with elevated INR levels which was managed with FFP. Removal of temporary pacemaker was attempted when she developed ventricular fibrillation and cardioversion was done . She underwent permanent pacemaker insertion and discharged on 10th post op day.


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