Anesthetic management of the medically compromised parturients differs greatly from non-parturients due to major physiological changes and alterations in organ anatomy during pregnancy. The most common high risk conditions in pregnancy include hypertension, pre-eclampsia, peripartum hemorrhage, congenital and valvular heart diseases, peripartum cardiomyopathy, renal disease, gestational diabetes mellitus, hyperthyroidism and obesity. The medically compromised parturients represent a real anesthetic challenge. Identifying proper anesthetic management helps to reduce morbidity and mortality to the mother and fetus.