Surveillance of aortic dissection/dissecting aortic aneurysm in pregnancy

Summary

Aortic dissection in pregnancy is a life-threatening event to both mother and baby and accounts for 14% of maternal cardiac deaths. Although rare, an association between pregnancy and aortic dissection has been reported and its incidence in pregnancy is thought to be rising. This study, using the UK Obstetric Surveillance System (UKOSS) aimed to estimate disease incidence, describe risk factors, management and outcomes with the intention of informing guidelines for the prevention and treatment of the condition. There were 12 confirmed cases of aortic dissection in pregnancy, giving an estimated national incidence of 0.8 cases per 100,000 maternities (95% CI: 0.5-1.5 per 100,000). The mean age of the women with the disease was 37 years. There were 7 cases were of type A aortic dissection and 3 of type B aortic dissection using Stanford criteria. Only one case was reported in association with Marfan's disease; one woman had preexisting aortic coarctation and a bicuspid aortic valve. Seventy-five percent of the women presented with anterior chest pain and 58% with back pain. Of the confirmed cases with full data available, 66% received antihypertensives mainly as an intravenous preparation (7/8 cases). Only two women required more than three anti-hypertensives to control blood pressure. Three women were managed conservatively whilst 5 women received an aortic root replacement. Overall there were 4 deaths and 8 survivors (case fatality 33%, 95% CI 10-65%). This study suggests that there are very few cases of aortic dissection in pregnancy in the UK and in this series two thirds of women survived this potentially devastating disease.