Pre-existing cardiac disease has profound effects on pregnancy and its outcomes. Severity of the cardiac ailment and its resultant functional impairment along with chronic tissue hypoxia determines the risk of fetal morbidity and mortality. Poor fetal outcome can however be minimized by preconceptional counseling, adequate prenatal care, intensive management of acute heart failure and prolonged hospitalization. The chapter covers classification of heart disease patients on the basis of New York Heart Association (NYHA), classification of mitral stenosis on the basis of severity, role of induction of labor in cardiac patients, indications of cesarean section in cardiac patients, infective endocarditis prophylaxis, management of labor in patient already on anticoagulation, recommendations for secondary prevention of rheumatic fever, etc.