Outcomes in pregnant women with acute aortic dissections: a review of the literature from 2003 to 2013

Int J Obstet Anesth. 2014 Nov;23(4):348-56. doi: 10.1016/j.ijoa.2014.05.001. Epub 2014 May 14.

Abstract

Background: Acute aortic dissection in pregnant women is a rare but potentially life-threatening event. Our aim was to evaluate maternal and fetal outcomes of acute aortic dissection during pregnancy.

Methods: We conducted a review of literature of the PubMed database to identify publications related to pregnant women with acute aortic dissections during the period 2003-2013: 59 articles were included in the study.

Results: A total of 75 patients were included in the analyses. Stanford type A dissections were the most common form, accounting for 77% of all cases. The majority (78%) occurred in the third trimester and immediate postpartum period. Inherited connective tissue disorders were causative in 49% of patients. Maternal mortality was not statistical different between type A and type B dissections (21% vs. 23%), but fetal outcomes were worse in type B dissections (35% vs. 10.3%; P<0.05). Fetal mortality in type A dissections was dependent on the timing of aortic repair, with antepartum aortic repair associated with a higher mortality (36%).

Conclusion: Despite advances in diagnostic and surgical techniques, maternal and fetal mortalities in pregnant patients with aortic dissection remain high. Patients undergoing combined cesarean section with aortic repair had favorable fetal outcomes.

Keywords: Aortic dissection; Fetal outcome; Maternal outcome; Pregnancy.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Adult
  • Aneurysm, Dissecting / complications*
  • Aneurysm, Dissecting / mortality
  • Aneurysm, Dissecting / surgery
  • Aortic Aneurysm / complications*
  • Aortic Aneurysm / mortality
  • Aortic Aneurysm / surgery
  • Connective Tissue Diseases / complications
  • Female
  • Humans
  • Pregnancy
  • Pregnancy Outcome / epidemiology*
  • Pregnancy Trimester, Third
  • Vascular Surgical Procedures