The incidence of undertaking emergency cardiac surgery during pregnancy remains rare, though presents a critical clinical scenario demanding rapid multidisciplinary coordination in order to safeguard both maternal and foetal outcomes. Indications for emergency surgery include aortic dissection, valvular disease, cardiac trauma and end-stage heart failure, demonstrating both the unique risks of such pathologies, and requirement for individualised care. However, the timing of such surgery relative to gestational age remains critical, with the second trimester conferring optimal haemodynamic stability and foetal viability. Considerations must also be paid to the physiological and haemodynamic adaptations experienced during pregnancy, including increased blood volume and cardiac output, altered coagulation and elevated oxygen requirements. Such changes directly influence surgical decision-making, particularly in the context of intraoperative considerations to maternal positioning, foetal monitoring and cardiopulmonary bypass management. This chapter underscores the importance of personalised care delivered by a cardio-obstetric team integrating surgical, obstetric and neonatal expertise in a time-sensitive scenario. As maternal age and cardiovascular risk factors increase globally, deciphering the complexities of emergency cardiac surgery during pregnancy becomes progressively vital in order to advance survival and long-term outcomes.