After completing this article, readers should be able to: 1. Describe how the cardiovascular changes of pregnancy can affect the woman who has cardiac disease. 2. Review the importance of preconception counseling. 3. Discuss the purpose of a multidisciplinary team approach to the management of the woman who has cardiac disease during pregnancy. 4. Review delivery management of women who have cardiac disease. Pregnancy causes considerable physiologic change in women, particularly in their cardiovascular systems. Circulating blood volume increases dramatically, and cardiac output increases up to 50% by the end of pregnancy. Pregnant women who have cardiac disease must be able to accommodate these normal changes to have a successful pregnancy. Inability to do so can result in increased morbidity and mortality. Cardiac disease is an important cause of nonobstetric mortality during pregnancy and can result in significant morbidity. (1)(2) Approximately 10% of all maternal deaths in the United States can be attributed to cardiac disease, a number that has remained consistent for the last half century. (1) In one study of 1,000 pregnant women who had various types of cardiac disease and were followed by the same health-care team over a 10-year period, more than 75% of the women had no complications during pregnancy. (2) Among the remaining 25%, the following complications were seen most often: The overall maternal mortality rate in this group was 2.7%, and the stillbirth and spontaneous abortion rate was 7.7%. Cardiac disease covers a wide range of conditions, including congenital heart disease, acquired disease such as rheumatic valvular disease, and coronary disease. It is estimated that 1% to 3% of women either have cardiac disease entering pregnancy or are diagnosed with cardiac disease while they are pregnant. …