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Preexisting valve disease can decompensate in pregnancy due to the need to increase cardiac output and intravascular volume. Decompensated valve disease in pregnancy presents in the same way as in the nonpregnant patient with symptoms of heart failure and pulmonary oedema. Stenotic valve disease is generally less well tolerated than regurgitant valve disease. In some parts of the world the prevalence of rheumatic valve disease remains high and often undiagnosed. Mitral stenosis in particular is frequently unmasked by pregnancy, and women with severe mitral stenosis should be discouraged from (or intervened upon prior to) pregnancy. Mitral valvotomy may bridge time to more definitive valve replacement once family planning is complete. Women with severe symptomatic aortic stenosis should be counseled against pregnancy while those without symptoms, good LV function and normal exercise tolerance may tolerate pregnancy under close surveillance by a specialist team [14]. There is an increased risk for mother and baby, namely intrauterine growth restriction, preterm birth and low birth weight. Fetal death occurs in <5% mothers with severe stenotic valve disease [15]. Women with mechanical valves on anticoagulation are at high risk of complications. A 2017 study from the UK suggests that only 28% of pregnancies resulted in favorable outcome for mother and baby [16], and ROPAC reports event free pregnancy with live birth in 79% in women with bioprosthetic valves, but only 58% in women with mechanical valve prostheses [17]. For these women there is a high risk of both valve thrombosis but also bleeding related to the need for full anticoagulation throughout pregnancy.