Management of maternal cardiac disease can be complex in pregnancy. Multidisciplinary obstetric care can enable women with underlying cardiac disease to have good pregnancy outcomes. As physiological changes related pregnancy can both manifest as and cause decompensation of cardiac disease, echocardiograms may be performed to identify women with cardiac dysfunction. In this small retrospective review, we review the echocardiogram results for pregnant women at Te Toka Tumai Auckland between 2019 -2024. 217 echocardiograms were performed for 164 patients for various indications. 44.7% of echocardiograms were performed in the 3rd trimester. 22.1% (48/217) of echocardiograms were requested for patients with a known cardiac condition, of which 25% had congenital cardiac disease, 45.8% had rheumatic heart disease (RHD). As New Zealand has high rates of rheumatic fever we reviewed the diagnosis, demographics and outcomes of pregnant patients with RHD. 59% of patients were Pacific peoples, 22% were NZ Māori. Of the 27 patients with RHD, mitral regurgitation was the most common valve lesion (19 patients). 18 patients had had prior surgical valve repair of RHD, although 0 required valve surgery in pregnancy. 6 patients had metal valve prostheses. 5 adverse cardiac events occurred for RHD patients including cardiogenic shock, arrhythmias, endocarditis and embolic complications. In our small sample size, when comparing mWHO risk prediction scores for patients with RHD observed rates of cardiac complications were lower than predicted in mWHO grade I and II patients, but higher in grades II-III, III and mWHO IV. 18.5% of patients with RHD delivered preterm.