Preconception counselling involves a full body check-up among other parameters to ascertain the probability of having a successful risk-free pregnancy. However, no pregnancy is risk-free. It is why every woman should access quality antenatal care. Some medical conditions make pregnancy very risky to the health of the woman. In such ailments, effective contraceptive methods become paramount.
Health care providers advise women with such medical conditions to delay pregnancy. Clinicians can stabilise these medical conditions well enough to have an uneventful pregnancy: others need advanced care to enable a woman to sustain the intricacies of pregnancy. Others still make the pregnancy a no-go zone. A few other medical conditions increase the likelihood of a miscarriage.
Effective contraceptive methods imply all of those methods that do not necessarily need correct use with every act of sex or abstaining during fertile days. They include spermicides, withdrawal, fertility awareness methods, cervical caps, diaphragms, female, and male condoms.
These medical conditions can be reproductive tract infections and disorders, cardiovascular diseases, systemic infections, endocrine disorders, anaemia, gastrointestinal diseases, neurological conditions, or rheumatologic diseases.
Breast cancer, endometrial and ovarian cancer, sexually transmitted infections and malignant gestational trophoblastic disease constitute a myriad of reproductive system disorders.
Cardiovascular diseases include hypertension (systolic blood pressure higher than 160 mm Hg or diastolic blood pressure higher than 100 mm Hg), severe valvular heart disease, ischaemic heart disease (heart disease due to narrowing of the arteries), stroke, and venous thromboembolism.
Having HIV and a woman isn’t on antiretroviral therapy puts her and the baby at an increased risk of adverse outcomes. Tuberculosis and schistosomiasis with liver fibrosis also make pregnancy very risky.
A woman with diabetes dependent on insulin, with damaged arteries, kidneys, eyes, or nervous system, or she’s had the condition for more than 20 years should be advised against conceiving because her body organs may not be in a position to sustain an uneventful pregnancy.
Sickle cell anaemia puts both the woman and the baby she will carry at risk of a myriad of complications, from relentless sickle cell crises to intrauterine growth restriction for the woman and the neonate respectively. We stabilise all women living with sickle-cell anaemia before allowing them to conceive.
Decompensated liver cirrhosis and malignant liver tumours will worsen and even lead to the death of a woman if the pregnancy comes into the picture. Counsel such women and provide effective contraception.
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Uncontrolled epilepsy makes pregnancy very risky as it potentiates the propensity of flares. Besides, a few anti-epileptic medications like phenytoin are contraindicated in pregnancy especially, in the first trimester, so, any woman with epilepsy should have her condition stabilised before she conceives otherwise, she is at substantial risk of adverse outcomes.
The systemic lupus erythematosus (SLE) makes pregnancy a risky venture. SLE may flare up and increases the risk of recurrent miscarriages. A woman with lupus should be counselled about the appropriateness of conception only when she is ready when her condition is under control.
Advise all women with these medical conditions about the risk of pregnancy to their health and the baby. Pay special attention to effective contraceptive methods. Women who consider options that require the correct use with every sexual act should ascertain whether they can use it effectively.
The WHO handbook about family planning comes in handy if you should know more about the medical conditions in pregnancy.
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