Pericardial effusion can present as one of the life-threatening emergencies requiring prompt diagnosis and immediate life-saving measures. We are presenting a case of a large pericardial effusion, tubercular in origin, in a pregnant woman with 31 31-week period of gestation. She presented with acute onset cough, dyspnea, and hemodynamic instability. She was managed successfully with pericardiocentesis and antitubercular therapy and later she had a normal vaginal delivery. Prompt and correct diagnosis and a team-based approach are the key to the management of such patients and a successful outcome.