Abstract
We present a complex case involving a 37-year-old pregnant woman at 13 weeks of gestation who developed respiratory failure. The patient had a known history of asthma, which initially created a diagnostic challenge, resulting in treatment for an acute asthma exacerbation. However, as the patient's clinical condition deteriorated, further investigations were conducted, leading to a diagnosis of severe rheumatic mitral valve stenosis. The patient underwent emergency mitral valve replacement, unfortunately resulting in a miscarriage. Nevertheless, the final maternal outcome was favourable.