# Clinical features of pregnancy-associated aortic dissection and pregnancy outcomes

## TL;DR

This study examines the clinical features and outcomes of aortic dissection during pregnancy, emphasizing the importance of timely diagnosis and treatment based on dissection type and gestational age.

## Contribution

The study provides insights into management strategies and outcomes for a rare condition, aortic dissection during pregnancy, based on a 13-year clinical analysis.

## Key findings

- Most aortic dissections during pregnancy occurred in late pregnancy or postpartum.
- Surgical repair was performed in 87.9% of cases, with higher mortality in type A dissections.
- Neonatal mortality was 6%, occurring exclusively in type A dissection cases.

## Abstract

Pregnancy complicated by aortic dissection is a rare and severe condition. Due to limited clinical experience, there are currently no standardized management guidelines. Therefore, we summarized and analyzed the clinical data of 33 patients with aortic dissection during pregnancy to gain relevant experience.

A total of 33 pregnant women with aortic dissection admitted to the First Affiliated Hospital of Zhengzhou University and the First Affiliated Hospital of Dali University during 13 years from February 1, 2012 to February 28, 2025 were included. The average age was 32.27 years (range: 23–43 years), and the average gestational age at the occurrence of aortic dissection was 31 ± 7 weeks. There were 17 cases (51.5%) of type A aortic dissection (TAAD) and 16 cases (48.5%) of type B aortic dissection (TBAD). Thirteen cases of TAAD (76.5%, 13/17) and ten cases of TBAD (62.5%, 10/16) occurred during late pregnancy or postpartum. Management strategies were based on anatomical type and gestational age (i.e., prioritizing surgery, medical management, or surgery followed by delivery).

Among the 33 patients, 29 (87.9%) underwent aortic repair surgery, including 14 cases of TAAD (82.4%, 14/17) and 15 cases of TBAD (93.8%, 15/16). A total of 28 patients underwent cesarean section. Among them, 13 cases of TAAD (76.5%, 13/17), 15 cases of TBAD (93.8%). Out of the 33 patients, 6 deaths occurred (18.2%), including 4 TAAD cases with a mortality rate of 23.5% and 2 TBAD cases with a mortality rate of 12.5%. The neonatal mortality rate was 6%, all occurring in TAAD cases.

For pregnant women presenting with thoracolumbar pain and a high suspicion of aortic dissection, timely computed tomography angiography (CTA) examination should be performed to avoid missed or delayed diagnosis. Management of aortic dissection during pregnancy should be based on the anatomical type and gestational age to determine the timing of surgery and delivery, which significantly influences maternal and fetal survival rates.