Pregnancy and contraception in heart disease and pulmonary arterial hypertension

Heart is the leading cause of maternal mortality in the UK. There is therefore a need to disseminate amongst the medical profession accurate information about contraception and pre-pregnancy counselling for women with heart disease. The risk of pregnancy depends on the specific and the individual patient. For example the risk of maternal death is up to 50% for those with pulmonary arterial hypertension but there is no anticipated extra risk for those with mild pulmonary stenosis compared to women without heart disease. Similarly although certain contraceptive methods are associated with unacceptable increases in risk for specific cardiac conditions it is not the case that most structural heart disease is an absolute contraindication for use of the combined oral contraceptive (COC). (excerpt)