Contraception in cardiac disease FSRH Jun 2014

Question 1

Contraception in cardiac disease

When to start preconception information

Answer 1

• 12- 15 years, depending on individual maturity
• Standard part of paeds to adult services
• Risk of contraception and pregnancy.
• Carry information when attending health services.

Question 2

Contraception in cardiac disease

VTE

Answer 2

• CHC: increased VTE

- Progestogen only contraceptives: causal association not but limited data

Question 3

Contraception in cardiac disease

Insertion & removal of IUD

Answer 3

• Prophylactic antibiotics not required (at risk of infective endocarditis)
• Vasovagal shock reaction may occur

Question 4

Contraception in cardiac disease

Interim method

Answer 4

• Desogestrel progesogen- only pill except for enzyme inducing medication.

Question 5

Contraception in cardiac disease

Intrauterine contraception

Answer 5

• Decision involve cardiologist
• Fitted in hospital setting: if vasovagal reaction presents particularly high risk.
  • • single ventricular circulation
  • • Eisenmenger’s physiology
  • • Tachycardia
  • -pre-existing bradycardia.

Question 6

Contraception in cardiac disease

Anticoagulant insertion of implants, injectables and IUS

Answer 6

• Risk of bleeding small. not restrict

- experience clinician

Question 7

Contraception in cardiac disease

Unintended pregnancy

Answer 7

• Opportunity to discuss risks
• Availability of abortion
• Once decided, avoid delays

Question 8

Contraception in cardiac disease

Sexual activity

Answer 8

• Let couple discuss concerns

- Reassure most of them: risk of cardiovascular event is very low.