Primary pulmonary hypertension (PPH) is a very uncommon clinical entity, with a high mortality when associated with pregnancy. Three cases of PPH associated with gestation and different outcomes are reported, and a literature review concerning its management and outcome is made. We emphasize the importance of a strict control of such patients, with the supportive cardiovascular measures and surveillance of fetal well-being. The peculiar handling of the course of delivery and the type of anaesthesia is discussed.