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.