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Contraception in women with heart conditions

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The Clinical Effectiveness Unit of the Faculty of Sexual and Reproductive Healthcare has recently published guidance on contraceptive choices for women with cardiac disease. Cardiac disease in women of childbearing age is more common as more children with congenital heart disease are living longer and there is an increased incidence of coronary heart disease.1 Cardiac disease is an important cause of maternal death in pregnancy in the UK.1

Women with a cardiac condition who become pregnant are at increased risk of cardiovascular complications. Intrauterine growth restriction and neonatal death may be associated with pregnancies complicated by maternal cardiac disease.1 At one end of the spectrum pregnant women with cardiac disease may present with the same level of risk of cardiovascular complications as women without a cardiac condition. However, at the other end of the spectrum pre-conceptual planning is important and pregnancy may not be advisable due to the impact on maternal health.

All contraceptive advice should be tailored to the individual by taking a thorough medical history, as well as assessing plans for having a family and the risk of sexually transmitted infections. The UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) may be helpful in considering contraceptive choices but patient preferences and clinical judgement need to be taken into account. A proactive approach should be taken to advising adol

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