Heart disease continues to be an important cause of maternal mortality. This is largely because of the extensive haemodynamic changes that occur during pregnancy, namely the increase in blood volume, fluctuations in cardiac output, fall in systemic vascular resistance and hypercoagulable state. High-risk periods include the end of the second trimester, labour and the immediate postpartum period. Prognosis depends on the specific heart condition, the patient's functional class and the degree of cardiac dysfunction. Conditions that are contra-indicated in pregnancy include Eisenmenger's syndrome, primary and secondary pulmonary hypertension, complex cyanotic congenital heart disease, Marfan's syndrome with aortic root dilatation, and severe left ventricular dysfunction. Women with heart disease should be thoroughly evaluated and counselled before and during pregnancy. Multidisciplinary care is essential for successful maternal and fetal outcomes.
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