PIP: All couples are entitled to contraception but it is an obligation for female heart patients whose pregnancies must be carefully planned and any dangerous or even incompatible pregnancy which would have to be terminated by therapeutic abortion must be prevented altogether. An effective and perfectly safe method is indispensable for such a high risk group. Tubal ligation, where partial reversibility may attenuate the psychological impact of permanent sterility might be considered after carefully weighing the numerous factors. Local contraception can only be justified to the extent that all methods are contraindicated. Use of an IUD entails the risk of bleeding if an anticoagulant is administered and infection in the case of exposed heart disease. Hormonal contraception with combined pills is always risky and low-dose pills have not been shown to be less harmful than regular ones from the cardiovascular point of view. From this standpoint, continuous progestogen-only minipills seem to be the safest method to be suggested as 1st choice. (author's modified)