An increased prevalence of cardiovascular disease (CVD ) has been found in women of reproductive age group. Pregnancy is associated with substantial physiologic changes that require adaptation of cardiovascular system. In this article we describe the changes in cardiac physiology encountered during pregnancy, and its effect on pre-existing cardiac disease. Important cardiac , maternal as well fetal assessment is elaborated. We outline the main cardiac pathology that can affect women during pregnancy and labour and provide a summary of the available evidence to guide management. Aspects of obstetric care that require adjustment in the presence of cardiac disease are highlighted. Pre-conceptional counselling is very important in patients with known cardiac disease. A team approach is needed to manage a pregnancy with cardiac disease to improve the outcome. It includes obstetrician, cardiologist, intensivist, anaesthetist, neonatologist. 

Keywords: Cardiovascular Disease ( CVD ); Pre-Conceptional Counselling; Oral Anticoagulant ( OAC ); Low Molecular Weight Heparin ( LMWH ); Unfractionated Heparin ( UFH ); Fetal Assessment.