Pregnancy and delivery are a potentially lethal combination in a patient with primary pulmonary hypertension. There are controversies regarding mode of delivery. Cesarean section is considered to be associated with extensive perioperative risks. We report on a parturient with severe pulmonary hypertension who underwent a succesful semiemergent cesarean section on vital indication. Vaginal delivery was excluded since her cervix was too immature for succesful induction. This is the first reported case of its kind to receive an epidural anesthesia with ropivacaine with its potential advantage of a low cardiac toxicity. The epidural was slowly and carefully titrated to give a stable anesthesia with good quality.