Abstract
With an increase in the level of immigration to the United Kingdom, there are more challenging cases presenting to the clinician with language and cultural differences as well as old friends revisited in terms of pathology In this case we present a 31 year old primigravida North African immigrant who managed to evade a diagnosis of Mitral Stenosis until presenting with acute pulmonary oedema during a Md Cavity Forceps Delivery (MCFD) under epidural anaesthesia This was a late diagnosis confounded by language barriers and a return of a classic condition perhaps more read about than actually seen in clinical practise. Issues related to the management of mitral stenosis are discussed along with some reflection on difficult communication issues, which exemplify the findings in the recent CEMACH 2007 report1.