Obstetric anesthesia management of the patient with cardiac disease

•The prevalence of cardiac disease in pregnancy is increasing.•Cardiac disease is a leading cause of maternal mortality.•Risk stratification models predict maternal and fetal morbidity and mortality.•High-risk patients should receive care from specialists at high-resource centers.•Coordinated, multidisciplinary care can result in successful outcomes. Cardiovascular disease is the leading cause of maternal mortality in much of the developed world. Risk stratification models can predict which patients are at greatest risk for maternal or fetal morbidity or mortality. Particular cardiac diseases hold significant risk of mortality during pregnancy including pulmonary hypertension, aortic aneurysm, left-ventricular outflow tract obstruction, and severe cardiomyopathy. High-risk patients should deliver at high-resource hospitals under the care of experts in cardiology, obstetrics, perinatology, neonatology and anesthesiology. The obstetric anesthesiologist should formulate delivery plans for cardiac monitoring, labor analgesia, cesarean anesthesia, postpartum monitoring, as well as plans for obstetric or cardiac emergencies. Carefully co-ordinated multidisciplinary care of pregnant women with cardiac disease can result in successful outcomes.