Maternal cardiac disease complicates up to 4% of pregnancies and is a major cause of maternal death. The anesthetic management of affected obstetric patients can be challenging and requires a thorough understanding of the cardiac pathophysiology and the physiological effects of pregnancy. The normal physiological changes of pregnancy result in a hyperdynamic cardiovascular system. These changes may significantly compromise the parturient with cardiac disease and affect anesthetic management for labor and delivery. Obstetric patients with cardiac disease require an early anesthesia consultation to allow appropriate anesthetic management to be determined. Vaginal delivery with a shortened second stage is usually preferred although there are some important exceptions. Cesarean delivery may be indicated in some patients with cardiac disease. Congenital heart disease (CHD) leads the cardiac causes of maternal morbidity and mortality. Postpartum monitoring should occur in a high dependency unit.