With recent advances in cardiovascular and neonatal medicine, the number of patients with heart disease who are giving birth has increased, and the range and severity of heart disease where pregnancy and delivery are possible are expanding. It is very important to understand that hemodynamics during pregnancy and delivery are significantly affected by changes in fluid circulation, hematology, respiratory function, endocrinology, and the autonomic nervous system for clinical management in peripartum women with heart disease. Because the cardiocirculatory changes associated with pregnancy and delivery are marked in some diseases and conditions, the maternal and fetal risks are high. Echocardiography is widely used to assess such maternal pregnancy risks. Echocardiography, a noninvasive method providing detailed information, is quite useful in evaluating hemodynamics during pregnancy. It is preferable that women with heart disease be assessed for hemodynamic status several times during pregnancy and during the puerperal period. The first assessment should be performed immediately before pregnancy or during the first trimester when changes in hemodynamics are still slight. Patients with mild to moderate risk should be evaluated for hemodynamics again during the late second trimester at around 30 weeks of gestation. Patients with severe risk require more frequent hemodynamic assessment. Hemodynamics should be reassessed during the peripartum period. Since childcare, including breast feeding, may increase cardiac load, patients with severe heart disease must be followed up carefully after childbirth.