Question

A primipara with a cardiac lesion (MI) has come on the 40th day of delivery asking for contraception. The contraceptive of choice is

• A. Condom with spermicidal jelly
• B. Oral contraceptive pill
• C. Intrauterine contraceptive device
• D. Laparoscopic sterilization

Hint:

Pick the method with no hormonal, surgical, or instrumentation risk for a cardiac patient.

Answer 1

The Correct Option is A

Step 1: Understanding the Question:
The patient is a first-time mother with a valvular heart lesion (mitral incompetence, abbreviated MI in this context), seen 40 days after delivery for contraceptive advice. We have to pick the safest option for her heart condition.

Step 2: Key Formula or Approach:
In a woman with cardiac disease, the contraceptive chosen must avoid extra strain on the heart: no added clotting risk, no procedure needing instrumentation or infection risk, and no surgery needing general anaesthesia unless truly necessary.

Step 3: Detailed Explanation:
Oral contraceptive pills contain estrogen, which raises the risk of venous thromboembolism and fluid retention, both of which are risky in a woman with a cardiac lesion.
An intrauterine contraceptive device carries a small risk of pelvic infection and a vasovagal reaction at the time of insertion, which is best avoided soon after delivery in a cardiac patient.
Laparoscopic sterilization needs general anaesthesia and a pneumoperitoneum, both of which put extra load on the heart and are not advisable this early after delivery in a cardiac patient; it can be planned later once she is stable.
A condom with spermicidal jelly is a barrier method with no hormonal or surgical risk at all, making it the safest choice while a permanent decision is deferred.

Step 4: Final Answer:
Condom with spermicidal jelly is the contraceptive of choice, option (A).