A collaborative clinic between contraception and sexual health services
and the adult congenital heart disease clinic
P. Rogers (1), D. Mansour (1), A. Mattinson (2), J. J. O’Sullivan (3)
Contraception and Sexual Health Service, Newcastle upon Tyne, UK (1);
Associate Specialist, Contraception and Sexual Health Service, Newcastle upon
Tyne, UK (2); Consultant in Paediatric Cardiology, Freeman Hospital, Newcastle
upon Tyne, UK (3)
Background: The success of cardiac surgery has created a new medical
community – the ‘grown-up’ congenital heart patients. Women with
congenital heart disease may need specialist advice about contraception and
pregnancy.
Objective: To investigate whether women with congenital heart disease
were receiving appropriate advice on contraception.
Methods: A contraceptive history was taken, via a predetermined form
on 46 consecutive female patients, consenting to see a family planning doctor,
at the adult congenital heart disease clinic, Freeman Hospital, Newcastle upon
Tyne.
Results: Sixteen women (35%) had never discussed contraception with a
health professional. One third of women who had previously discussed
contraception with either their GP or family planning clinic had received
inappropriate advice. There had been eight unplanned pregnancies in seven women.
Thirteen out of eighteen women using condoms as their main method of
contraception changed to a more reliable hormonal method. Four out of seven
women not using any contraception started on a hormonal method. Two women
changed their hormonal contraception to a more reliable method. There was a poor
knowledge among the women about hormonal methods particularly Depo-provera and
Implanon.
Conclusions: There is poor provision of contraceptive advice for women
with congenital heart disease. A lot of women are unaware of the methods
available to them. Many women had not received any advice or had been given
inappropriate advice. Simply denying hormonal methods due to uncertainty is not
adequate advice. Contraception and pregnancy should be raised with all female
patients with congenital heart disease. Informed advice is vital to avoid the
potential risks of an unplanned pregnancy. A combined clinic between the
cardiologist and family planning doctor offers the optimal informed advice as
neither alone has expertise in the other’s field.
