ABC | Volume 114, Nº5, May 2020

Statement Brazilian Cardiology Society Statement for Management of Pregnancy and Family Planning in Women with Heart Disease – 2020 Arq Bras Cardiol. 2020; 114(5):849-942 Table 44 – Main causes of cardiorespiratory arrest in pregnant women and maternal mortality Letter Causes Etiology A Accident/trauma Anesthetic complications High neuraxial block Hypotension Bronchoaspiration Respiratory depression Respiratory airway obstruction Trauma Suicide B Bleeding Coagulopathy Uterine atony Placenta accreta Placenta praevia Uterine rupture Premature placental abruption Transfusion reaction Retained products of conception C Cardiovascular causes Acute infarction Dissection of the aorta Cardiomyopathy Arrhythmias Valve disease Congenital heart disease D Drugs Oxytocin Magnesium Illicit drugs Opioids Insulin E Embolic causes Amniotic fluid embolism Pulmonary embolism Cerebrovascular event F Fever Infection Sepsis G General H’s (hypovolemia, hypoxia, hypoglycemia, hypokalemia, hyperkalemia, hypothermia) T’s (tension pneumothorax, cardiac tamponade, toxicity, infarction, and pulmonary thromboembolism) H Hypertension Preeclampsia Eclampsia HELLP syndrome Intraparenchymal bleeding HELLP: hemolysis, elevated liver enzymes, and low platelet count. 6.1.1. Key Points • Family planning is essential for women with heart disease, regarding both risk stratification for pregnancy and contraceptive choice; • Risk predictors should be defined before pregnancy; • The risk classification elaborated by the WHO is currently the most accepted; • Resources for attendance and availability of a specialized multidisciplinary team should be considered during pregnancy counseling. 6.2. Contraception in Patients with Cardiovascular Disease 6.2.1. Different Contraceptive Methods Contraception is the use of methods and techniques with the aim of impeding sexual relations from resulting in pregnancy. It is a family planning resource for constituting desired and consciously planned reproduction. There are currently numerous known contraceptive strategies, which may be grouped into the following categories: behavior‑based methods, barrier methods, intrauterine devices (IUD), hormonal methods, and surgical methods. Hormonal methods include combined (containing estrogen and progestin) and progestin-only methods. The former include combined pills, vaginal rings, patches, and monthly ingestions. Progestin-only methods include progestin-only pills, quarterly injections, etonogestrel subdermal implant, and levonorgestrel-releasing IUD. Understanding that different means of contraception present different mechanisms of action, adverse event profiles, beneficial non-contraceptive effects, which vary according to any given clinical context, is the basis for selecting the most appropriate contraceptive method; it is also indispensable to evaluate patients’ wishes and expectations, in addition to their beliefs regarding the method, in order to optimize adherence. 923