This chapter addresses the management of pregnancy in women with mechanical heart valves and discusses the maternal and fetal risks associated with the different anticoagulant options, to enable clinicians and women to make the most informed choice in this challenging clinical situation. Thromboembolic complications of mechanical valves include valve thrombosis, causing valve obstruction or systemic embolization, mainly cerebrovascular accidents (CVA) but also myocardial infarction or embolization into peripheral arteries. Systemic thromboembolism can develop from either obstructed or non-obstructed valves. Oral anticoagulants, such as warfarin and acenocoumarol, are the most effective agents for prevention of valve thrombosis and systemic thromboembolism during pregnancy in women with mechanical heart valves. Management of women in the peri-delivery period requires close clinical monitoring, given the bleeding risks associated with therapeutic anticoagulation. A planned delivery allows for better control and adjustment of anticoagulation.