Cirrhosis in pregnancy is associated with higher maternal and fetal morbidity and mortality. Management of decompensated cirrhosis is further complicated by the unique hemostatic alterations of pregnancy superimposed on cirrhosis-related coagulopathy. Anesthetic care in this setting requires careful consideration of airway management, choice of anesthetic technique, and rapid correction of coagulopathy in collaboration with obstetrics and hepatology. We present a case of a patient with underlying cirrhosis with acute decompensation during pregnancy further complicated by placental abruption requiring emergent dilation and evacuation.