Counseling reproductive health issues in women with congenital heart disease

Abstract

Current counseling practice for pregnancy and contraception in women with CHD is inadequate. Failure to give knowledgeable family planning advice appropriate for the individual risk profile in this high-risk patient group can have hazardous consequences and cause an unnecessary risk for mother and child. Many doctors fail to confront their patients with congenital heart defects early with issues of regarding sexuality, pregnancy and contraception and to advise them adequately. A cooperative approach involving congenital cardiologists as well as experienced gynecological endocrinologists with appropriate knowledge about CHD is indispensable.

Perception of Nurse-Midwives on Factors Influencing Oral Contraceptives Use, Misuse, Nonuse and Discontinuation among Clients in Ibadan, Nigeria

“…Similarly, Nelson et al 28 obtained that difficulty in obtaining contraception was significantly associated with discontinuation and may reflect difficulty with transportation, uncertain living conditions, and work schedules. Perceptions that clinic queues were too long or the distance of the clinic from their homes supported previous reports 19,20,23 . Some clients actively wanted to become pregnant due to lack of attitude to education.…”

“…It was however suggested that failure of NMs to respond to their clients concerns may lead to them stopping the pills. For example, in two different studies, it was reported that women's options for contraception are often limited by misperceptions of risks by both health care providers and patients 19,20 . And that providers lack of knowledge and discomfort counseling about contraceptive options may place women at greater risk for unplanned, higher risk pregnancies 21 .…”

“…Though, switching OC methods is a common phenomenon, previous studies found that up to 80% of women who discontinue or switch, do so to less effective methods 24,25 . Recently, in other countries, women with some medical problems claimed to have received less or inappropriate counseling, placing them at increased risk for unintended pregnancy 19,20 . This further explains why often time users may rely on less effective barrier methods or use no contraceptive method at all which may in chance increase their risk of unintended and undesired pregnancy.…”

“…This further explains why often time users may rely on less effective barrier methods or use no contraceptive method at all which may in chance increase their risk of unintended and undesired pregnancy. There are available evidences that when used properly, OC certainly can plummet pregnancy risk from a specific sex act but users retain their right to this medication in order to realize this important benefit 20,21,24 . From the NMs points of view, an altered menses due to OC would most times normalize itself, although, this may be in part due to humoral feedback mechanism.…”

State of Family Planning

“…According to some studies, as a result of provider unfamiliarity with LARC methods or uneasiness with any contraceptive method containing hormones, the majority of women with chronic medical conditions are using only minimal to moderately effective forms of contraception with high failure rates, such as combined oral contraceptive pills, barrier methods, natural family planning, or withdrawal. [73][74][75][76][77][78] In June 2006, ACOG released a practice bulletin to discuss contraceptive choices for women with chronic medical conditions 79 as unintended pregnancy rates in this population of women is equal to that of their healthy peers. 80 The recommendation is that these women, in concert with their obstetrician and other care teams, optimize disease status before pregnancy, such that disease exacerbation is minimized and fetal and perinatal outcomes are improved.…”