This study was conducted on 60 pregnant women with prosthetic Mitral valve on anticoagulant therapy. Our cases were followed up in high risk obstetric unit Kasr El-Aini hospital, Cairo University to investigate the outcome of pregnancy as regard fetal and maternal morbidity and mortality. We found that 8.3% of our cases had hemorrhagic complications, 1.7% had stuck valve, 1.7% had infective endocarditis and neonatal complications was 3.3%. In our study We also found that mode and timing of delivery was not affected by the mitral valve prosthesis. We concluded that The best approach to manage such patients is unfractionated heparin in the first trimester then warfarin till 36th week guided by INR then Un Fractionated Heparin till delivery.