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Introduction: Superior Vena Cava Syndrome is a rare but potentially life-threatening condition that can occur during pregnancy. The case presented here describes a dramatic presentation culminating in a potentially preventable maternal death at a tertiary hospital in East Africa.

Case presentation: A HIV positive, 28 years old primegravida at a gestational age of 34 weeks presented to a tertiary health facility in Nothern Tanzania with generalised facial swelling and difficulty in breathing. She was referred from primary health facility where she was treated presumptively as a case of Ludwings angina. On examination she was dyspnoeic and had extensive supraclavicular and cervical lymphadenopathy. On second day post-admission, she was induced, but later her condition deteriorated and developed severe dyspnoeic, confusion, convulsions and died. A Narrative of this case, challenges encountered in investigating, establishes a diagnosis and management are explored in this case report. Furthermore pathophysiology and treatment options for superior venal caval occurring in pregnancy will be reviewed.

Conclusion: Superior vena syndrome is a fatal condition and rare to occur in pregnancy. A rigorous and timely approach to investigate and manage is of a critical importance. Additionally a collaborative multidisciplinary team approach is necessary to prevent complication.