Author reply

Abstract

We thank Morton for the opportunity to respond to his recent letter, in which he succinctly summarises the dilemmas facing women of child-bearing age with moderate to severe pulmonary arterial hypertension (PAH). 1 Very often, pregnancy is absolutely contraindicated because of high maternal mortality rates and the fear of teratogenicity or poor growth in the foetus. The decision regarding contraception or sterilisation is individualised according to the underlying cause, and severity of the PAH, as well as unique patient factors. As such, we routinely discuss our recommendations in this regard with each patient, in an early consultation.Where pregnancy will always be dangerous, we favour a permanent contraceptive solution for the female (rather than for the partner). In our multidisciplinary PAH clinic, described previously, 2 we recommend the Essure device (Conceptus Incorported, Mountain View, CA, USA) or laparoscopic tubal ligation with the involvement of a cardiac anaesthetist in a tertiary care environment only. Otherwise, we recommend a depot progesterone or an intrauterine device, recognising that no single solution is ideal and that advice needs to be individualised to take into account the circumstances, motivation and preferences of the patient.