A para 2 poorly compensated cardiac patient has delivered 2 days back. You will advice her to:

Contraception in patient of heart disease: Temporary contraception of choice: Barrier contraceptives (condoms) but they have high failure rate, so nowadays progesterone only contraceptives like minipills are being advised (Ref Mgt of high risk pregnancy, Manju puri, S Strivedi p376) Contraception to be avoided: – OCPs – Intrauterine devices Permanent contraception of choice: Best: Husband should be advised vasectomy especially in patients whose heart is not well-compensated. If husband refuses or, if heart of the patient is well-compensated-Tubectomy is advised. Female sterilisation: Best time: At the end of first post partum week. Method: Mininlaparotomy (never do laproscopic sterilisation in heart disease patient). Anaesthesia of choice: Local anaesthesia.