Document Type : Original Article
Authors
1 Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
3 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
4 Department of Obstetrics and Gynaecology, School of Medicine, Al‑Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
BACKGROUND: Nowadays, for various reasons, the prevalence of heart diseases has increased in
women during reproductive age. These diseases can lead to serious reproductive and sexual‑related
complications in the affected women. This study will conduct to develop a reproductive health
promotion program for women with heart diseases.
MATERIALS AND METHODS: This is an exploratory sequential mixed methods study that will
be conducted in four phases. The first phase is a qualitative research that is done using content
analysis method and semi‑structured individual interviews. The experiences of women with heart
disease and health providers’ team in educational hospitals, health centers, and private offices of
physicians about reproductive health need will be explored. Purposive sampling will be continued
until data saturation is reached and the conventional content analysis method will be used. In the
second phase, the studies published from 2000 to 2020 will be reviewed by the matrix method and
then will be analyzed by using thematic analysis. Integrating the results of these two stages, the draft
of the program will be designed. In the third phase, the validation of the program will be checked by
using the two‑round modified Delphi method. In the fourth phase, the program will be implemented
by the health system and its process will be monitored.
CONCLUSION: A life cycle reproductive health program for women with heart disease can help
improve their preconception health, fertility planning, and sexual health and promote the well‑being
of these women in the long run.
Keywords
- Cordina R, Nasir Ahmad S, Kotchetkova I, Eveborn G, Pressley L,
Ayer J, et al. Management errors in adults with congenital heart
disease: Prevalence, sources, and consequences. Eur Heart J
2018;39:982‑9.
2. Moons P, Bovijn L, Budts W, Belmans A, Gewillig M. Temporal
trends in survival to adulthood among patients born with
congenital heart disease from 1970 to 1992 in Belgium. Circulation
2010;122:2264‑72.
3. Roos‑Hesselink J, BarisL, JohnsonM, de BackerJ, OttoC, MarelliA,
et al. Pregnancy outcomes in women with cardiovascular disease:
Evolving trends over 10 years in the ESC registry of pregnancy
and cardiac disease (ROPAC). Eur Heart J 2019;40:3848‑55.
4. FSRH. FSRH Clinical Guideline: Contraceptive Choices for
Women with Cardiac Disease London Faculty of Sexual and
Reproductive Healthcare; 2014. Access in: https://www.fsrh.
org/standards-and-guidance/documents/ceu-guidancecontraceptive-choices-for-women-with-cardiac/: [Last accessed
on 2020 Jan 21].
5. Simpson LL. Maternal cardiac disease: Update for the clinician.
Obstet Gynecol 2012;119:345‑59.
6. Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL,
Casey BM, et al. Williams’s Obstetrics. 25th ed.. New York: McGraw
Hill; 2018.
7. Shadab P, Nekuei N, Yadegarfar GH. Prevalence of pre‑pregnancy
risk factors and its relationship with preconception care in
Isfahan‑Iran. Int J Pediatr 2017;5:5463‑71.
8. Knight M, Kenyon S, Brocklehurst P, Neilson J, Shakespeare J,
Kurinczuk JJ, editors. On Behalf of MBRRACE‑UK. Saving
Lives, Improving Mothers’ Care‑Lessons learned to inform
future maternity care from the UK and Ireland Confidential
Enquiries into Maternal Deaths and Morbidity 2009–12.
Oxford: National Perinatal Epidemiology Unit, University of
Oxford; 2014. Available from: https://www.npeu.ox.ac.uk/
downloads/files/mbrrace‑uk/reports/Saving%20Lives%20
Improving%20Mothers%20Care%20report%202014%20Full.
pdf. [Last accessed‑ on 2020 Oct 24].
9. Díaz Antón B, Villar Ruíz O, Granda Nistal C, Martín Asenjo R,
Jiménez López‑Guarch C, Escribano Subias P. Pregnancy in
women with structural heart disease: experience in a centre. Rev
Esp Cardiol (Engl Ed) 2015;68:1189‑90.
10. Yucel E, DeFaria Yeh D. Pregnancy in women with congenital
heart disease. Curr Treat Options Cardiovasc Med 2017;19:73.
11. Roos‑Hesselink JW, Ruys TP, Stein JI, Thilén U, Webb GD,
Niwa K, et al. Outcome of pregnancy in patients with structural
or ischaemic heart disease: Results of a registry of the European
Society of Cardiology. Eur Heart J 2013;34:657‑65.
12. Cauldwell M, Ghonim S, Uebing A, Swan L, Steer PJ, Gatzoulis M,
et al. Preconception counseling, predicting risk and outcomes
in women with mWHO 3 and 4 heart disease. Int J Cardiol
2017;234:76‑80.
13. FSRH Clinical Effectiveness Unit. FSRH Clinical Guideline:
Contraceptive Choices for from: Women with Cardiac Disease.
Faculty of Sexual & Reproductive Healthcare; 2014.
14. Meskhi N, Zhidovinov A, Pitirimova O. On the issue of
preconception care in patients with pathology of the cardiovascular
system. Arch Euromed 2018;8:59‑65.
15. Cauldwell M, Steer PJ, Swan L, PatelRR, Gatzoulis MA, Uebing A,
et al. Pre‑pregnancy counseling for women with heart disease:
A prospective study. Int J Cardiol 2017;240:374‑8.
16. Hinze A, Kutty S, Sayles H, Sandene EK, Meza J, Kugler JD.
Reproductive and contraceptive counseling received by adult
women with congenital heart disease: A risk‑based analysis.
Congenit Heart Dis 2013;8:20‑31.
17. Pijuan‑Domènech A, Baró‑Mariné F, Rojas‑Torrijos M, Dos‑Subirà
L, Pedrosa‑Del Moral V, Subirana‑Domènech MT, et al. Usefulness
of progesterone‑only components for contraception in patients
with congenital heart disease. Am J Cardiol 2013;112:590‑3.
18. Neiman A, Ginde S, Earing MG, Bartz PJ, Cohen S. The prevalence
of sexual dysfunction and its association with quality of life in
adults with congenital heart disease. Int J Cardiol 2017;228:953‑7.
19. Roushias S, Ossei‑Gerning N. Sexual function and cardiovascular
disease: what the general cardiologist needs to know. Heart
2019;105:160‑8.
20. Huang S, Cook SC. It is not taboo: Addressing sexual function in
adults with congenital heart disease. Curr Cardiol Rep 2018;20:93.
21. Berglund A, Lindmark G. Preconception health and care (PHC)‑a
strategy for improved maternal and child health. Ups J Med Sci
2016;121:216‑21.
22. Sabouri M, Shakibazadeh E, Mohebbi B, Tol A, Yaseri M, Babaee S.
Effectiveness of an educational intervention using theory of
planned behavior on health care empowerment among married
reproductive‑age women: A randomized controlled trial. J Educ
Health Promot 2020;9:293.
23. Karimi N, Saadat‑Gharin S, Tol A, Sadeghi R, Yaseri M,
Mohebbi B. A problem‑based learning health literacy intervention
program on improving health‑promoting behaviors among girl
students. J Educ Health Promot 2019;8:251.
24. Shakibazadeh E, Sabouri M, Mohebbi B, Tol A, Yaseri M. Validity
and reliability properties of the Persian version of perceived health
competence scale among patients with cardiovascular diseases.
J Educ Health Promot 2021;10:19.
25. European Society of Gynecology (ESG), Association for
European Paediatric Cardiology (AEPC), German Society for
Gender Medicine (DGesGM), Regitz‑Zagrosek V, Blomstrom
Lundqvist C, Borghi C, et al. ESC Guidelines on the management
of cardiovascular diseases during pregnancy: The Task Force on
the Management of Cardiovascular Diseases during Pregnancy
of the European Society of Cardiology (ESC). Eur Heart J
2011;32:3147‑97.
26. North West of England Adult Congenital Heart Disease Strategic
Board, Cardiac Disease in Pregnancy Regional Clinical Guidance
and Referral Protocol for the Management of Congenital and
Acquired Cardiac Disease from Preconception to the Postnatal
Period, Cardiac Disease in Pregnancy Guidance–Final Version 2:
February 2012. Available from: http://www.nwcscnsenate.nhs.
uk/files/8114/3817/3126/Attachment_4_Cardiac_Disease_in_
Pregnancy_Protocol_FINAL_210412.pdf. Last accessed on: 2021
April 12
27. Sliwa K, Azibani F, Baard J, Osman A, Zühlke L, Lachmann A, et al.
Reducing late maternal death due to cardiovascular disease‑A
pragmatic pilot study. Int J Cardiol 2018;272:70‑6. - 28. Pillutla P, Nguyen T, Markovic D, Canobbio M, Koos BJ,
Aboulhosn JA. Cardiovascular and Neonatal Outcomes in
Pregnant Women With High‑Risk Congenital Heart Disease. Am
J Cardiol 2016;117:1672‑7.
29. Yaseen I, Ali FH. Registries for cardiac disease in pregnancy: An
effective tool for organizing multidisciplinary team with better
outcomes. J Am Coll Cardiol 2018;71 11 Suppl: A2130.
30. Ministry of Health and Medical Education. National guidelines
for the care of patients with heart diseases during pregnancy and
postpartum, Tehran, Iran; 2015. Available from: http://ta.mui.
ac.ir/sites/ta.mui.ac.ir/files/123780.pdf. [Last accessed on 2020
Oct 24].
31. Mayer F, Bick D, Taylor C. Multidisciplinary care for pregnant
women with cardiac disease: A mixed methods evaluation. Int J
Nurs Stud 2018;85:96‑105.
32. Anderson KN, Tepper NK, Downing K, Ailes EC, Abarbanell G,
Farr SL. Contraceptive methods of privately insured US women
with congenital heart defects. Am Heart J 2020;222:38‑45.
33. Easter SR, Valente AM, Economy KE. Creating a Multidisciplinary
Pregnancy Heart Team. Curr Treat Options Cardiovasc Med
2020;22:3.
34. Tromop‑van Dalen C, Fairley SL, Aitken A, Grace Li WY.
Contraception and Pre‑conception counselling in cardiac
patients: We can do better. Experience from a tertiary centre in
New Zealand. Heart Lung Circ 2021;30:158‑61.
)