Contraception after heart transplantation
Spina, V.; Aleandri, V.; Salvi, M.
Minerva Ginecologica 50(12): 539-543
1998
ISSN/ISBN: 0026-4784 PMID: 10069168 Document Number: 491988
During the period of 1988-97, in the medical literature, 24 cases of pregnancy were reported in women who had undergone heart transplant operations (18 of them with positive outcome). There were 3 cases of spontaneous abortion between the 8th and 14th weeks of pregnancy. The clinical condition of 19 newborns (one case of twins) was good in 15 cases and pathological in 4 cases. The choice of a contraceptive for such women has to take into account the immunosuppressive therapy that is often associated with arterial hypertension. IUDs may increase the risk of infection, but barrier methods are well suited for such women. However, the use of oral contraceptives (OCs) is more controversial because of their effects on lipid and carbohydrate metabolism, on arterial pressure, and coagulation. However, the new types of OCs with less than 35 mcg of ethinyl estradiol do not seem to alter coagulative homeostasis or increase the risk of thromboembolism. Prior to becoming pregnant, among the 24 cases of pregnancy 2 had been dissuaded of using contraception, 2 had used spermicides, 2 others had used barrier methods, and 3 resorted to abortion, while in the rest of the cases the contraceptive was not specified. In one case observed by the authors, the patient had used a low-dose OC for 4 years (0.030 mg ethinyl estradiol and 0.075 mg gestodene) prior to pregnancy and pregnancy occurred when the OC use was suspended at her own decision. No side effects occurred during OC use nor was there any need for increasing the doses of antihypertensive drugs.