It was observed that fertility and menstrual function in heart-transplanted women, impaired before the operation, become normal with a new heart. The restoration of reproductive function is also confirmed by many cases of pregnancy in heart-transplant recipients, reported in the literature. Twenty-four cases were published worldwide up to 1997, out of which eighteen had a positive result. Also a case personally treated was successful. The outcome of a pregnancy after heart transplantation is, then, generally positive. Nevertheless, such a pregnancy involves important maternal and fetal risks. Thus, the gynecologist has to provide correct information about both such risks and the most suitable contraceptive methods, for these patients. Oral contraceptives are very effective and, in the new low-dose formulations, free from serious adverse effects. No adverse effects have been observed in our patient, who represents the only case, reported in the literature, in which an estroprogestinic contraception was utilized before a pregnancy. In conclusion, during an oral contraception or after a tubal sterilization, pregnancy is really unlikely to occur. Thus, when the couple either has completed the familial nucleus or does not desire offspring, a doubt is at least justified as to whether these safer methods of contraception are advisable in such women.
PIP: 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.