TEALE FENNING

Maud · Joined: 11 Oct 2007 Posts: 73 Location: Bristol

Absolute contraindications:

Any past proven arterial or venous thrombosis
Ischaemic heart disease or angina

severe or combined risk factors for venous or arterial disease
known atherogenic lipid disorders (unless chloesterol brought <8 mmol/L, might then become WHO 3, check with her physician)
Specific prothrombotic abnl of coagulation/fibrinolysis, incl congenital thrombophilias with abnl levels of individual factors and presence of any acquired thrombophilia, esp antiphospholipid syndrome.
severe polycythaemia
Klippel-Trenaunay syndrome
Sturge-Weber syndrome
blood dyscrasias
polyarteritis nodosa
scleroderma
severe SLE
post splenectomy with plt >500 (WHO 3 if <500)

elective major or leg surgery from 2w before until 2w after mobilization
leg immobilisation (eg fracture)
after varicose vein treatments
high altitude with other risk factors (WHO 3 without risk factors)
severe inflammatory bowel disease during attacks (WHO3 in remission)

migraine with focal aura
severe migraine
TIA's
past cerebral haemorrhage (WHO 3 if succesful surgery for aneurysm)

pulm hypertension
pulm vascular disease

active liver disease (liver tests currently abnl)
pill related cholestatic jaundice (WHO 3 if only in pregnancy)
Dubin-Johnson and Rotor syndromes
(note: Gilbert's is WHO2)
liver adenoma or ca
focal nodular hyperplasia (possibly WHO3 with careful imaging during F/U)
acute porphyria's (others are WHO 2 or 3)

chorea
COC induced hypertension
pancreatitis due to hyperglyceridaemia
Pemphigoid gestationis
Steven-Johnsons syndrome (erythema multi forme), if COC-associated
trophoblastic disease until hCG undetectable

existing or possible pregnancy

undiagnosed genital tract bleeding

current breast cancer

allergy to contituent of tablets

haemolytic uraemic syndrome, incl past history
thrombotic thrombocytopenic purpura, incl past history
past benign intracranial hypertension
amaurosis fugax

woman's own continuing anxiety re COC safety, unrelieved after councelling

Maud · Joined: 11 Oct 2007 Posts: 73 Location: Bristol

WHO 4 heart disease:

atrial fibrillation or flutter (WHO 3 if on warfarin)
pulm hypertension or pulm vascular disease
pulm A-V malformation
poor left ventricular function (LV ejection fraction <30%)
dilated cardiomyopathy with residual LV dysfunction
dilated L atrium >4 cm
cyanotic heart disease (even with warfarin)
post-surgery Fontan heart (even with Warfarin)
Bjork Shiley or Starr Edwards valves (even with warfarin)

Maud · Joined: 11 Oct 2007 Posts: 73 Location: Bristol

After any viral hepatitis, severe infectious mononucleosis or other reversible hepatocellular damage, COC may be resumed 3 months after liver function tests have returned to normal.

Nick Raine-Fenning · Posted: Thu Aug 14, 2008 9:16 pm Post subject:

Thanks Maud - this is very useful.

N