•We report a case of a 29-year-old woman in her first pregnancy who was diagnosed with SSS three years prior, after presenting with recurrent blackouts.

•She underwent permanent pacemaker implantation, which significantly improved her symptoms, with only occasional episodes of palpitations. She was maintained on cardioselective beta-blocker therapy with bisoprolol, and her pacemaker function was closely monitored.

•During her pregnancy, she remained under close follow-up with cardiologists. While she experienced occasional palpitations, her symptoms were otherwise well-controlled. Bisoprolol therapy was continued throughout her pregnancy, with serial fetal growth scans performed to monitor for potential growth restriction due to beta-blocker use. The fetal growth remained within normal limits.

•At 39 weeks of gestation, she went into spontaneous labor. Epidural analgesia was provided for pain relief, and she had a successful vaginal delivery without complications

•In patients with IIH and having LP shunts, pregnancy should be closely monitored for the development of signs and symptoms of raised intracranial pressure.

• If having a vaginal delivery it is advisable not to have prolonged expulsive effects in the second stage, particularly when the shunt is malfunctioning.

• For the CS general anaesthesia is advised over spinal anaesthesia due to the risk that anaesthetic medications may leak into the peritoneal cavity. But in high-risk patients like obese and having difficult airways spinal anaesthesia can be used.