Tetralogy of Fallot is the most common cyanotic congenital heart disease. Women with this condition may become pregnant, and it is important to detect the disease to prevent cardiovascular complications and to reduce maternal and fetal death. The purpose of this paper is to report the case of a pregnant patient with no previous diagnosis of uncorrected tetralogy of Fallot, who reached the end of pregnancy with added diagnoses of severe preeclampsia and HELLP syndrome. For accurate information about the natural history of tetralogy of Fallot it is necessary to review the literature of the past 30 years because there is no recently published series. It is common for patients with tetralogy of Fallot and pregnancy to suffer a gradual increase in the severity of pulmonary stenosis, with exacerbation of symptoms and increased cyanosis. The long-term prognosis is extremely poor in the absence of correction, with a mortality of 10%.