Objective: The aim of the present study was to evaluate the effect of severe maternal cardiac disease during pregnancy on mode of delivery and adverse perinatal outcomes.Material and Methods: The study comprised 108 pregnant women with cardiac disorder who delivered at a tertiary care center hospital between 2010 and 2020. Mode of delivery, adverse maternal and perinatal outcomes was interpreted according to the woman’s status based on her type of heart disease and a modified World Health Organization classification.Results: The distributions of the women according to the modified World Health Organization classifications were 56.4%, 26.8%, 11.2%, and 5.6% for WHO classes I, II, III, and IV, respectively. The ratios of cardiac diseases were 65.7%, 21.2%, and 13.1%, respectively, for rheumatic, and congenital heart disorder, and others. Nulliparity, ethnicity, and history of caesarean section rates were similar among the classes. Gestational age at delivery and birth weight were significantly lower in classes III–IV than in classes I–II. Prematurity, small for gestational age rates, and admission to neonatal intensive care unit were increased in classes III–IV compared to those in classes I–II. While vaginal delivery rates were 54 (60%) in Class I-II and 10 (55.5%) in Class III-IV, the cesarean section rates were 36 (40%) in Class I-II and 8 (44.5%) in Class III-IV. There was a significant difference between the cesarean section rates. The presence of adverse obstetrical outcomes was similar among the classes. During this period, a total of 3 maternal mortalities occurred. Maternal morbidity and maternal mortality were increased in classes III–IV compared those in classes I–II.Conclusion: Pregnant women with cardiac diseases should be administered using a multidisciplinary approach that combines consultants from both obstetrics and cardiology to reduce maternal mortality and morbidity and adverse fetal outcomes.