The Yellow River, with a developmental and historical significance to China, is now facing several emerging pressures, which are degrading the river status and creating challenges for high-quality development in the basin. Numerous studies on such emerging pressures, present scattered outcomes, and trigger uncertainties and deficient assumptions on the river's problems. This review integrated such scattered information and investigated the emerging pressures, their drivers and integrated impacts at the basin level. The study intended to prioritize those pressures needing expeditious consideration, and carried a discussion on the alternative pathways to the solution. To determine the critical emerging pressures, a literature review was conducted and experts' opinion was sought. The outcome further led to a comprehensive review, data collection, and analysis of three groups of emerging pressures. The review recognized ‘Water Stress’ in the lower reach, primarily caused by an abated flow, as the most distressing emerging pressure inflicting social, ecological, and economic consequences. Such decline in flow was mostly induced by a recent increase in ‘Anthropogenic activities’, such as intensive water withdrawal for irrigation (≥27 BCM), and construction of check dams in the Loess Plateau region (trapping~5 BCM water). The increasing ‘Pollution’ in the river, besides threatening public health and ecology, also contributed to the water stress by rendering certain stretches of the river biologically dead and unsuitable for any use. The ‘Climate Change’, with its key negative effect on precipitation in the middle sub-basin, overall contributed small (8–11 %) to the observed reduction in river flow. With increasing challenges for the adopted engineering solutions tackling the water stress, the study suggested the use of a demand management approach, employing adaptive policy measures, as an alternative or supplementary solution to the current approach. In addition, the study highlights that regular reviewing and reforming the key decisions based on evidence and updated information, and taking a participatory approach, may offer a sustainable pathway to the environment as well as socio-economic goals.