A primigravid woman suffered a prolonged cardiac arrest at 18 weeks of gestation. Dilated ischemic cardiomyopathy was diagnosed. After recovery, the patient received an implantable cardioverter-defibrillator. At 38 weeks of gestation she had an elective caesarean delivery. Both mother and child had a favourable outcome. The effect of pregnancy on underlying cardiac disease and the management of maternal cardiac arrest with a pre-viable fetus are discussed. The importance of a multidisciplinary approach is emphasized. Continued neurodevelopmental assessment of the newborn is necessary to detect the long-term effects of fetal hypoxia in early pregnancy.