Aortic dissection in pregnancy: A life‐threatening disease and a diagnosis of worth considering

Abstract

Acute aortic dissection is a life-threatening disease. To increase the awareness of this diagnosis as a cause of feto-maternal mortality during pregnancy, we have analyzed risk factors using information from five pregnant women admitted for acute aortic dissection to the Karolinska University Hospital over an eight-year period (1999-2007). Four of the women died and only one survived. One fetus was stillborn and all newborn infants showed signs of asphyxia at birth. Of the women, who were on average five years above the mean age for delivery in Sweden, three had hypertension, two had first-degree relatives with aortic dissection which had occurred during the second half of pregnancy (gestational age at diagnosis 26-41 weeks). The most common presenting symptoms were severe back, abdominal and leg pain, and confusion. If a rapid diagnosis is not made, the risk of mortality for both mother and fetus is high. The incidence of aortic rupture during pregnancy in Sweden appears to be 14.5/1,000,000 and the case maternal fatality ratio 4.4/1,000,000.

Maternal mortality attributable to vascular dissection and rupture in the Netherlands: a nationwide confidential enquiry

“…1 There is much debate about whether pregnancy may contribute to the pathogenesis of vascular dissections. [2][3][4][5][6] Cardiovascular changes in pregnancy and decreasing peripheral vascular resistance may increase the risk of arterial aneurysm and dissection during pregnancy. 7 Also, the high levels of female hormones during pregnancy are believed to affect the structure and integrity of major arteries.…”

A Vaginal Stillbirth after Aortic Surgery of Type B Aortic Dissection in a Pregnant Woman

“…6) The fetal mortality rate was reported to be as high as 35% in type B aortic dissections. 2,6,7) The reason for such a high fetal mortality may be that the extension of dissections affecting the internal iliac arteries results in uterine and placental hypoperfusion which leads to intrauterine fetal death. 2,4,5) Timely diagnosis and management are the keys to decrease fetal mortality.…”

“…7) However, when the fetus is confirmed dead, the aortic surgery should be performed first for the sake of the mother's health, particularly for a woman with unstable signs. In our case, emergent aortic surgery was performed to guarantee the mother's safety.…”

Hybrid surgical reconstruction of aorta dissection manifested during pregnancy

“…По данным литературы, расслоение аорты может развиться в любой период беременности [1,2,6], однако наиболее часто встречается в третьем триме-стре (51% случаев) и послеродовой период (20% слу-чаев) [7]. В первом и втором триместрах беремен-ности риск расслоения аорты минимален и состав-ляет 6% и 10%, соответственно [8].…”

“…Острая диссекция аорты типа А по классифика-ции Stanford редко осложняет течение беременности, однако ассоциируется с высоким риском летального исхода как матери, так и плода [1]. При этом леталь-ность у беременных не отличается от значений при данном заболевании в общей когорте пациентов и составляет "1% каждый час" в первые двое суток, достигая 80% в течение первых двух недель заболева-ния [2,3].…”