Anomalous systemic arterial supply to the basal segment of the lung (ABLL) is a rare cause of haemoptysis. ABLL may be complicated by massive haemoptysis, heart failure due to left-to-right shunt and infection. We describe a case of this condition presenting in the third trimester of pregnancy. Computed tomography chest angiogram confirmed the diagnosis. A multidisciplinary approach was necessary to determine treatment, which ultimately consisted of elective caesarean section at 36 weeks and 4 days' gestation, followed by transarterial embolisation 9 days postpartum.