Contraception and Pre-Conception Counselling in Cardiac Patients: We Can Do Better. Experience From a Tertiary Centre in New Zealand

Abstract

Physiological changes in pregnancy can precipitate decompensation in women with pre-existing cardiac disease leading to suboptimal fetal outcome in addition to maternal risk. Many women born with congenital heart disease are living into childbearing years, and rheumatic heart disease (RHD) remains a significant problem within Māori and Pasifika communities in New Zealand. To assess documentation of contraception advice and pre-conception counselling in women with pre-existing cardiac disease of childbearing potential and to explore potential barriers to these conversations. We conducted a retrospective review of electronic clinic letters of 194 women with modified World Health Organization (mWHO) class 2 or above heart disease. This was followed by a survey of our cardiology team. Fifty-one (51) women with RHD and 143 women with non-RHD were identified. Thirty-eight per cent (38%) of women had documented discussions about contraception and pre-conception counselling. Women with RHD were less likely to receive discussions about contraception than women with non-RHD. All surveyed members of our cardiology team agreed that women with cardiac disease should have planned pregnancies and the majority reported always or usually discussing contraception. Factors such as lack of time, cultural barriers and presence of family members were identified. Many felt that the subject was outside of their expertise or admitted that they simply did not think about it. Advice regarding contraception in addition to pre-pregnancy counselling should be given to all patients with pre-existing cardiovascular disease of potential child-bearing potential. Our study shows much room for improvement.