Cardiac disease is the main cause of maternal mortality in the UK; therefore, accurate and appropriate contraceptive advice for women with cardiac disease is an essential part of any consultation. All females should be counseled regarding pregnancy and contraception before they become sexually active, with information tailored to their diagnosis and risks of a pregnancy. In this review, we discuss current clinical recommendations and practice in a number of different cardiac conditions, including congenital heart disease, as well as highlighting future developments and challenges with contraception in women with cardiac disease.
Papers of special note have been highlighted as either of interest (•) or of considerable interest (••) to readers.
2.
de SwietMN: Why Mothers Die. 6th Report of the Confidential Enquiries into Maternal Deaths in the UK.Royal College of Obstetrics and Gynaecology, London, UK (2004).
3.
Confidential enquiry providing detailed information regarding the maternal risks of pregnancy.
4.
ThomeSMacGregorANelson-PiercyC: Risks of contraception and pregnancy in heart disease. Heart92, 1520–1525 (2006).
5.
Provides a good review of pregnancy and contraception risks.
6.
ThomeSNelson-PiercyCMacGregorA: Pregnancy and contraception in heart disease and pulmonary arterial hypertension. J. Fam. Plann. Reprod. Health Care32, 75–81 (2006).
7.
SteerPJGatzoulisMABakerP: Heart Disease and Pregnancy.Royal College of Obstetrics and Gynaecology, London, UK (2006).
8.
Background text on heart disease and pregnancy.
9.
MacmahonBMcKeownTRecordRG: The incidence and life expectation of children with congenital heart disease. Br. Heart J.15, 121–129 (1953).
10.
WrenCO'SullivanJJ: Survival with congenital heart disease and need for follow up in adult life. Heart85, 438–443 (2001).
11.
Report of the British Cardiac Society Working Party: Grown-up congenital heart (GUCH) disease: current needs and provision of service for adolescents and adults with congenital heart disease in the UK. Heart88(Suppl. 1), 11–114 (2002).
12.
ThorneSA: Pregnancy in heart disease. Heart90, 450–456 (2004).
13.
WeissBMvon SegesserLKAlonESeifertBTurinaMI: Outcome of cardiovascular surgery and pregnancy: a systematic review of the period 1984–1996. Am. J. Obstet. Gynecol.179, 1643–1653 (1998).
14.
GuillebaudJ: Medical-eligibility criteria for contraceptive use. Lancet357, 1378–1379 (2001).
15.
TrussellJ: Contraceptive Efficacy.MediaA (Ed.). Contraceptive Tecnology, NY, USA (2004).
16.
SiuSCSermerMColmanJM: Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation104, 515–521 (2001).
17.
Seminal paper on risks in pregnancy.
18.
WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception.Acute myocardial infarction and combined oral contraceptives: results of an international multicentre case–control study. Lancet349, 1202–1209 (1997).
19.
FarmerRDLawrensonRAToddJCWilliamsTJMacRaeK: Oral contraceptives and venous thromboembolic disease. Analyses of the UK General Practice Research Database and the UK Mediplus database. Hum. Reprod. Update5, 688–706 (1999).
20.
LechatPMasJLLascaultG: Prevalence of patent foramen ovale in patients with stroke. N. Engl. J. Med.318, 1148–1152 (1988).
21.
HarelZRiggsSVazRFlanaganPDunnKHarelD: Adolescents' experience with the combined estrogen and progestin transdermal contraceptive method Ortho Evra. J. Pediatr. Adolesc. Gynecol.18, 85–90 (2005).
22.
SarkarNN: The combined contraceptive vaginal device (NuvaRing): a comprehensive review. Eur. J. Contracept. Reprod. Health Care10, 73–78 (2005).
23.
RoumenFJBergMMHoomansEH: The combined contraceptive vaginal ring (NuvaRing): first experience in daily clinical practice in The Netherlands. Eur. J. Contracept. Reprod. Health Care11, 14–22 (2006).
24.
KorverTKlippingCHeger-MahnDDuijkersIvan OstaGDiebenT: Maintenance of ovulation inhibition with the 75-microg desogestrel-only contraceptive pill (Cerazette) after scheduled 12-h delays in tablet intake. Contraception71, 8–13 (2005).
25.
SorensenMBCollinsPOngPJ: Long-term use of contraceptive depot medroxyprogesterone acetate in young women impairs arterial endothelial function assessed by cardiovascular magnetic resonance. Circulation106, 1646–1651 (2002).
26.
DingemanseJvan GiersbergenPL: Clinical pharmacology of bosentan, a dual endothelin receptor antagonist. Clin. Pharmacokinet.43, 1089–1115 (2004).
27.
PetersonHBXiaZHughesJMWilcoxLSTylorLRTrussellJ: The risk of pregnancy after tubal sterilization: findings from the U.S. Collaborative Review of Sterilization. Am. J. Obstet. Gynecol.174, 1161–1168; discussion 1168–1170 (1996).
28.
DuffySMarshFRogersonL: Female sterilisation: a cohort controlled comparative study of ESSURE versus laparoscopic sterilisation. Br. J. Obstet. Gynaecol.112, 1522–1528 (2005).
29.
Hastings-TolsmaMNodinePTealSB: Essure: hysteroscopic sterilization. J. Midwifery Womens Health51, 510–514 (2006).
30.
Task Force on Postovulatory Methods of Fertility Regulation.Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. Lancet352, 428–433 (1998).
