Aim and objective: The aim of the study was to assess efficacy of CARPREG II risk prediction index in predicting poor maternal outcomes in pregnancies with heart diseases. Materials and methods: This study was conducted in the department of obstetrics and gynecology at a tertiary care center in Mumbai. This was a retrospective study of 66 pregnant women with structural heart diseases. CARPREG II score was calculated for each patient as per history, clinical examination, specific lesion through echo findings, and delivery of antenatal care. Primary and secondary adverse cardiac outcomes were noted during antepartum and postpartum periods. Obstetric and perinatal outcomes were also recorded. Results: Mean age of the study population was 27.36 years. A total of 51.5% (n = 34) patients were primigravidae. Majority of the subjects about 59.09% (n = 39) had rheumatic heart diseases (RHDs) and 25.75% (n = 17) had congenital heart diseases (CHDs). Overall, vaginal delivery was the most common route with an increased rate of Cesarean section (41.07%) and instrumental vaginal delivery (16.6%). There was no significant difference in observed and expected values of primary maternal outcome (p value = 0.9). All the maternal adverse clinical events were more common in groups of patients with CARPREG II index of 4 or more, but in score <3, the risk index overestimated maternal adverse cardiac events. Perinatal complications did not show any correlation with CARPREG II score. Conclusion: Pregnancy with cardiac disease is associated with high maternal and fetal morbidity and mortality. CAREPREG II risk prediction index predicts maternal outcomes effectively and can be used routinely in clinical practices to assess the maternal risks. Clinical significance: Integration of general cardiac factors and disease-specific factors along with delivery of care predictor emphasizes the role of skilled antenatal care in improving outcomes in pregnancy with cardiac diseases.