Mitral valve gradients are expected to increase in the setting of pregnancy, and may lead to adverse maternal outcomes. Serial imaging, heart rate control, volume management and anticoagulation are useful in caring for pregnant women with MS. While most women may undergo vaginal delivery, some may need consideration of assisted second stage or Cesarean delivery depending on disease severity and clinical status.LA – Left atrial. MVA – Mitral Valve Area. MS – Mitral Stenosis. HR – Heart Rate. *Anticoagulation is indicated for atrial fibrillation, left atrial thrombosis, prior embolism, severe MS, spontaneous echo contrast in the LA, Left atrial volume index ≥60 mL/m2, or heart failure.