Anesthetic management of the medically compromised parturientsdiffers greatly from non-parturients due to major physiologicalchanges and alterations in organ anatomy during pregnancy inaddition to altered pharmacokinetics and pharmacodynamics ofanesthetic agents during pregnancy. The most common anestheticchallenges are peripartum hemorrhage, fetal distress, difficultairway, morbid obesity, pregnancy-induced hypertension,pulmonary embolism, congenital and valvular heart diseases,peripartum cardiomyopathy, acute myocardial infarction, andfinally maternal cardiac arrest and cardiopulmonary resuscitation.The medically compromised parturients represents a realanesthetic challenge. Identifying proper anesthetic managementhelps to reduce morbidity and mortality to the mother and fetus.