Congenital Heart Disease

1. The safest and most efficacious contraception choice for the female patient with severe congenital heart disease (CHD) is…

a. Mirena IUS

b. Barrier contraception

c. Implanon

d. Sterilization

i. The risk of vasovagal response during insertion makes Implanon a safer choice for females with severe CHD. Although there is no additional cardiac risk, barrier contraception is not a reliable method for efficacy for patients with severe CHD. Aside from the higher failure rates in young women and that Implanon and Mirena IUS are more efficacious, the surgery itself requires long-term head-tilts and filling of the abdomen with carbon dioxide, both of which stand to compromise the stability of the patient with CHD.

2. Which of the following is NOT a risk for the fetus of a woman with CHD?

a. Fetal loss

b. Macrosomia

c. Premature birth

d. Intracranial hemorrhage

i. Fetal loss, premature birth, and intracranial hemorrhage are all risks to the fetus for a woman with CHD. Macrosomia is not a risk.

3. Sexual activity is not contraindicated in mild-moderate CHD.

a. True

b. False

i. Sexual activity is allowed in CHD as long as the patient can tolerate the activity.

4. The main reason estrogen-progesterone methods of birth control are not recommended for women with CHD is...

a. The risk of ectopic pregnancy is higher with this type of birth control.

b. Weight gain is higher with this type of method and should be avoided in women with CHD.

c. Pregnancy in a woman with CHD is contraindicated so more permanent methods should be taken to prevent it.

d. They have the potential to form more clots than other methods.

i. The risk of ectopic pregnancy is higher with sterilization and IUS, not with estrogen-progesterone methods. Weight gain is not a contraindication for this type of method. Pregnancy is contraindicated only in the most severe form of CHD where it would be life threatening. Most women with CHD can become pregnant and deliver while being followed by a multi-disciplinary team.

5. Sterilization is the safest and most efficacious method of birth control for women with CHD.

a. True

b. False

i. IUS and Implanon are more efficacious than sterilization. Also, the sterilization procedures have inherent risks to women with CHD.