Acute Type A Aortic Dissection in a 37-Week Pregnant Patient: An Unusual Clinical Presentation

Lee, Sun Hwa; Ryu, Seokyong; Choi, Seoung Won; Kim, Hye Jin; Kang, Tae Kyug; Oh, Sung Chan; Cho, Suk Jin; Lee, Jae Hoon; Chung, Eun Cheol; Kim, Myoung-Hwan

doi:10.1016/j.jemermed.2016.09.001

Cited by 9 publications

(11 citation statements)

References 18 publications

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“…The common risks of aortic disease were gene disorders and hypertension, thus the pregnancy with high blood pressure or Marfan syndrome, Ehlers-Danlos syndrome … should be confirm the differential diagnosis with aortic dissension or rupture when they had acute chest pain [[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]].…”

Section: Discussionmentioning

confidence: 99%

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Successful emergency management for aortic arch rupture in pregnancy at first trimesters: A case report

Tran

2019

International Journal of Surgery Case Reports

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Section: Discussionmentioning

confidence: 99%

“…Hemodynamic and hormonal changes in pregnancy increase the risks the cardiovascular events, and the common risks of aortic disease include hypertension, gene mutation related to extracellular matrix disorders such as Marfan syndrome, Ehlers Danlos syndrome, bicuspid aortic valve and trauma [[1], [2], [3], [4], [5], [6], [7], [8]].…”

Section: Introductionmentioning

confidence: 99%

Successful emergency management for aortic arch rupture in pregnancy at first trimesters: A case report

Tran

2019

International Journal of Surgery Case Reports

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“…There are a significant number of case reports in the literature, which describe the use of PoCUS in exceptional circumstances. Examples of this include the diagnosis of uterine rupture, cervical ectopics, DVTs and pulmonary oedema associated with pre‐eclampsia, and fetal abnormalities and abnormal dopplers . This can be misleading as it suggests that clinician in the emergency or outpatient settings will be able to make these diagnoses themselves.…”

Section: Scope Of Practicementioning

confidence: 99%

Point‐of‐care ultrasound in obstetrics

Collins¹,

Collins

Kothari

2019

Australas J Ultrason Med

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Point-of-care ultrasound, or PoCUS, where imaging is undertaken at the bedside, clinic or emergency department (ED) by the clinician overseeing treatment, is a rapid form of assessment that may be undertaken alongside or as an alternative to traditional, formal ultrasound performed by a radiology service. PoCUS reduces the time to diagnosis, thus allowing lifesaving treatment to be initiated. This is particularly relevant in Obstetrics and Gynaecology (OBGYN), where delayed diagnosis of pregnancy complications is often fatal or highly debilitating to the mother or fetus. The literature suggests that PoCUS is particularly useful in areas that are inadequately resourced, as it is relatively cheap and accessible. High-quality training is essential to ensure that the staff performing the scans are adequately qualified to deliver the service. Clinicians who perform PoCUS in their practice should be aware of the appropriate indications, as well as when to refer for formal imaging.

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“…LCUS should be combined with a clinical risk assessment [(modified) Wells’ criteria] and D-dimer [ 13 ]. Although the accuracy of LCUS is lower than that of a radiologist performed US [ 14 ], when the negative LCUS is repeated after 1 week, it has been shown to be safe to withhold anticoagulation treatment if no thrombosis has been identified. The risk of a thromboembolic complication after two negative LCUS examinations parallels that of a single whole-leg ultrasound, being 0.6% during the 3-month follow-up [ 6 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although the accuracy of LCUS is lower than that of a radiologist performed US [ 14 ], when the negative LCUS is repeated after 1 week, it has been shown to be safe to withhold anticoagulation treatment if no thrombosis has been identified. The risk of a thromboembolic complication after two negative LCUS examinations parallels that of a single whole-leg ultrasound, being 0.6% during the 3-month follow-up [ 6 , 14 , 15 ]. It has been shown that using LCUS in primary health care can reduce the number of patients referred to hospital significantly, by 73% [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Cost-minimization modeling of venous thromboembolism diagnostics: performing limited compression ultrasound in primary health care reduces costs compared to referring patients to a hospital

et al. 2021

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Background The aim of this retrospective study was to determine whether diagnosing a deep venous thrombosis (DVT) in primary health care using limited compression ultrasound (LCUS) can save resources compared to referring these patients to hospital. According to the current literature, LCUS is as safe as a standard protocol based on a whole-leg ultrasound (US). Methods We created a standardized patient for this cost-analysis model based on 76 patients that were referred to hospital for a suspected DVT. Travel distance to the health care centre and hospital was calculated based on the home address. Hospital costs were acquired from the hospital price list and Finnish legislation. Time spent in the hospital was retrieved from hospital statistics. Time spent in the health care centre and travelling were estimated and monetized based on average salary. The cost of participating physicians attending a US training course was estimated based on the national average salary of a general practitioner as well as the course participation fee. A cost-minimization modeling was performed for this standardized patient comparing the total costs, including private and public costs, of standard and LCUS strategies. Results The total costs per patient of standard and LCUS pathways were 1151.52€ and 301.94€ [difference 849.59€ (95% CI 800.21€–898.97€, p < 0.001)], respectively. The real-life costs of these strategies, considering that some patients are probably referred to hospital every year and including training costs, are 1151.53€ and 508.69€ [difference 642.84€ (95% CI 541.85€–743.82€)], respectively. Conclusion Using LCUS in diagnosing DVT in primary health care instead of referring these patients to the hospital is shown to save a significant amount of public and private resources.

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Acute Type A Aortic Dissection in a 37-Week Pregnant Patient: An Unusual Clinical Presentation

Cited by 9 publications

References 18 publications

Successful emergency management for aortic arch rupture in pregnancy at first trimesters: A case report

Successful emergency management for aortic arch rupture in pregnancy at first trimesters: A case report

Point‐of‐care ultrasound in obstetrics

Cost-minimization modeling of venous thromboembolism diagnostics: performing limited compression ultrasound in primary health care reduces costs compared to referring patients to a hospital

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