Women with heart disease may develop cardiac complications during pregnancy. The risk of these complications can be estimated by assessing the severity of the patient’s valvular lesions and ventricular dysfunction. I. Examination items: 1. A thorough medical history is needed to assess the presence of previous heart failure, transient ischemic attack, stroke, and arrhythmia. 2. Physical examination: presence or absence of cyanosis, activity limitation, and cardiac function classification. 3. echocardiography: manifestation of left heart obstruction, manifestation of left ventricular systolic dysfunction 4. electrocardiography: arrhythmias II. RELATED STUDIES: To determine the risk and predictors of pregnancy-related cardiac complications in women with heart disease, a retrospective study analyzed 252 pregnancy outcomes in 221 women with heart disease (spontaneous abortions were excluded). The results were then applied to a prospective study that included 562 women with congenital or acquired heart disease or arrhythmias and a total of 617 pregnancies. The four predictors of cardiac events were: 1. poor cardiac function class [NewYorkHeartAssociation (NYHA) class II-IV] or cyanosis. 2. previous cardiac events (e.g., heart failure, transient ischemic attack, stroke) or arrhythmias 3. left heart obstruction (mitral valve area <2 cm2, aortic valve area <1.5 cm2, peak left ventricular outflow tract pressure gradient >30 mmHg) 4. left ventricular systolic dysfunction [left ventricular ejection fraction ( leftventricularejectionfraction(LVEF)<40%] 1 point was scored for each factor present, and the risk was estimated based on the total score. III. Scoring and risk prediction: 1. The overall actual incidence of major cardiac events (pulmonary edema, arrhythmia requiring treatment, stroke, cardiac arrest, or death) was 13%, of which 55% occurred in the prenatal period. 2. There was excellent agreement between the predicted and actual observed incidence of cardiac events by risk score: 0 was 5% vs. 4%, 1 was 27% vs. 26%, and >1 was 75% vs. 62%. 3. Women with a score of 0 and no lesion-specific risk issues had a lower risk of cardiac events and often delivered safely in a community health facility. Neonatal outcome and risk score prediction: Neonatal outcome is also associated with the mother’s risk score. Neonatal complications occurred in 1/3 of women younger than 20 years or older than 35 years who had obstetric risk factors, smoked, or received anticoagulation therapy and had a risk score of ≥1; the proportion was 11% in matched controls without cardiac disease. V. Women with heart disease should receive a complete evaluation when seeking medical consultation before or early in pregnancy: this includes an echocardiogram. Those with a risk score ≥1 require more frequent evaluation, requiring close collaboration between the patient’s cardiologist and obstetrician. Women at highest risk should be referred to a maternal-fetal medicine specialist (high-risk obstetrician) for pregnancy management.