Background and Aims Coarctation of aorta represents 6%-8% of CHD with associated Patent ductus arteriosus. Arnold chiari malformation is characterized by prolapse of cerebellar tonsils below the foramen magnum causing compressive symptoms.The primary goal is to minimize the incidence of haemodynamic stressor response and brainstem herniation which is a possible risk with endotracheal intubation.

Methods A case of 24year G2P1L0 with 34weeks POG, a known case of ACM was diagnosed with COA and PDA. She was planned for elective caesarean due to uncontrolled upper limb hypertension. Examination revealed pansystolic murmur and Loud P2 with suzzman’s sign positive. She had feeble femoral pulse with radiofemoral delay. Uppler limb BP : 190/100 mmhg and lowerlimb BP: 130/80 mmhg. 2DEcho revealed Large PDA with left to right shunt, dilated RA, RV. Severe COA with PPG 76 mmhg. Trivial TR with PPG 40 mmhg. No sensory and motor deficits noted. Graded epidural anaesthesia was administered.

Results Parturient with congenital anomalies has been successfully managed perioperatively with graded epidural doses and by providing adequate post-operative analgesia.

Conclusions Parturient with Coarctation of the aorta and Arnold chiari malformation presents with unique challenges to the anaesthetist and management must be tailored to avoid hemodynamic instability and associated risk of tonsillar herniation. The use of epidural anaesthesia in graded dose was successful in achieving this goal.