Cardiac disease is the leading cause of maternal mortality in the
developed world. The majority of women with heart disease are
able to successfully undergo pregnancy. However, in women with
severely impaired ventricular function, severe left heart obstruction,
pulmonary hypertension and aortopathy, such as Marfan
syndrome, with significant aortic dilatation, pregnancy is associated
with a significant risk, and these women should be counselled
against pregnancy if there is no option for treatment that reduces
risk. Although there are increasing numbers of women with
congenital heart disease who are considering pregnancy, as a
result of joint expert specialist cardiac and obstetric care, maternal
mortality is low. Most of the observed mortality occurs in women
with structurally normal hearts who were not known to have heart
disease before their pregnancy. It is therefore important that those
caring for pregnant women are aware of the risk factors for and
presentation of cardiac conditions in pregnancy. We review the
presentation and management of both congenital and acquired
heart diseases in pregnancy.