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 Figure 14 – Pearl indexes of the main contraceptive methods. Adapted from Curtis et al. 417 Most Effective Less than 1 pregnancy per 100 women in a year 6-12 pregnancies per 100 women in a year 18 or more pregnancies per 100 women in a year Least Effective Reversible Permanent Implant Injectable Male Condom Female Condom Spermicide Fertility-Awareness Based Methods Withdrawal Sponge Pill Patch Ring Diaphragm Male Sterilization (Vasectomy) Female Sterilization (Abdominal, Laparoscopic, Hysteroscopic) Intrauterine Device (IUD) 0.05% 6% 18% 21% 24% 28% 22% 24% parous women 12% nulliparous women 9% 9% 9% 12% 0.15% 0.5% LNG - 0.2% Copper T - 0.8% Table 48 – Categories of medical eligibility criteria for contraceptive choice. Condition for which there is no restriction regarding use of the contraceptive method Condition where the advantages of using the method generally outweigh theoretical or proven risks Condition where the theoretical or proven risks outweigh the advantages of using the method Condition that represents an unacceptable health risk if the contraceptive method were used Adapted from the World Health Organization, 2015. 421 occurred after hormonal contraceptive use, it should be changed to a non-hormonal method. In this clinical context, combined methods, also should be avoided. 428,429 Table 52 shows the medical eligibility criteria of different contraceptive methods in relation to patients with previous cardiovascular events. 6.2.3.5. Obesity In the absence of other clinical conditions, obese patients do not have contraindications to the use of any method. Furthermore, even if it is necessary to investigate metabolic syndrome and screen for other cardiovascular conditions due to obesity, the results of complementary examinations should not delay the introduction of contraceptive methods. 430 With respect to quarterly injections (150-mg doses of intramuscular depot medroxyprogesterone acetate), there is a Brazilian study showing significantly higher weight gain in women using quarterly injections, in comparison with copper IUD. 431 For this reason, quarterly injections are not typically the first choice; there is, however, no formal contraindication, and the method may be used. Specifically in obese women, there is a theoretical concern that methods may be less efficacious. Even if this is the case, their efficacy continues to be high; for this reason, they should not be contraindicated. 6.2.3.6. Congenital Heart Disease Contraception counseling in patients with congenital heart disease begins at menarche, with advice regarding the risks of gestation and choice of contraception method. Congenital heart diseases are not explicitly listed in the WHO’s eligibility criteria, and they should be understood within 926