1. Transplant pts
1.1. 43% are repro age
1.1.1. pregnacy risks
1.1.1.1. IUGR
1.1.1.2. PPROM
1.1.1.3. Pre-E
1.1.1.4. PTL
1.1.1.5. HTN
1.1.1.6. teratogenic effects
1.1.1.7. Organ rejection
1.1.2. 93% of pregnancies are unplanned
1.2. type of transplant
1.2.1. 61% kidney
1.2.2. 13% liver
2. CDC MEC
2.1. don't forget to assess for other comorbidities too
2.2. "complicated" transplant
2.2.1. 4: CHC
2.2.2. 3: Initiating an IUD
2.2.3. 2: All other methods, continuing an IUD
2.3. "uncomplicated" transplant
2.3.1. 2: All methods
3. Contra counseling
3.1. Avoid preg x 12-24 mo
3.2. Pt desires
3.2.1. desires fertility
3.2.1.1. discuss risks of pregnancy
3.2.2. doesn't desire fertility
3.2.2.1. consider sterilization
3.3. Misconceptions
3.3.1. up to half (44%) don't realize they're fertile
3.3.2. Little change in sexual activity s/p transplant
3.3.2.1. ~60% have regular sex
4. Method-related concerns
4.1. Oral CHC: see MEC
4.2. Other CHC
4.2.1. Ring: safe and effective if CHC OK
4.2.2. Minimal data for other CHC
4.3. IUDs
4.3.1. minimal data
4.3.2. theoretical risks
4.3.2.1. increased failure rate
4.3.2.1.1. due to lack of cell-mediated immunity
4.3.2.2. increased infection rate
4.3.2.2.1. due to immunosuppression
4.3.2.2.2. not supported by data in HIV pts
5. Health condition considerations
5.1. thrombotic risk
5.2. Immunosuppression
5.3. Med interactions
5.4. hematologic conditions
5.4.1. Risk of AUB
5.4.2. risk of menorrhagia/anemia
5.5. hepatic function
5.5.1. drug metabolism