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Aortic dissection during pregnancy and puerperium: A Japanese nationwide survey
Author(s) -
Tanaka Hiroaki,
Kamiya Chizuko A.,
Horiuchi Chinami,
Morisaki Hiroko,
Tanaka Kayo,
Katsuragi Shinji,
Hayata Eijiro,
Hasegawa Junichi,
Nakata Masahiko,
Sekizawa Akihiko,
Ishiwata Isamu,
Ikeda Tomoaki
Publication year - 2021
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.14657
Subject(s) - medicine , aortic dissection , pregnancy , obstetrics , dissection (medical) , marfan syndrome , postpartum period , mortality rate , surgery , aorta , genetics , biology
Aim This study aimed to characterize the incidence and clinical significance of pregnancy‐related aortic dissection using a large‐scale survey in Japan. Methods A questionnaire requesting the detailed information included in the clinical charts of pregnancy‐related aortic dissection cases (without any personally identifying information) was designed between 2013 and 2017 and administered to 407 perinatal centers in Japan. The response rate was 70.5%. Seventeen cases of pregnancy‐related aortic dissection were identified. Results Maternal death due to aortic dissection was observed in nine patients (56.2%) while seven survived (43.8%). Dissection occurred during the postpartum period in 10 cases (62.5%), the third trimester in 4 (25.0%), labor in 1 (6.2%), and the second trimester in 1 (6.2%). The most common underlying diseases were: Marfan syndrome (25.0%), Loeys‐Dietz syndrome (6.2%), hypertension (6.2%), and Takayasu aortitis (6.2%). Stanford type A aortic dissection was associated with maternal death during both pregnancy and the postpartum period. However, deceased patients showed lower rates of pre‐diagnosed connective tissue disease than did survivors. Conclusions The mortality rate of aortic dissection that occurred during pregnancy or postnatal periods was more than 50%. Aortic dissection occurred more frequently in the postnatal period than during pregnancy, and less frequently in women previously diagnosed with connective tissue disease than in women without any medical history of aortic disorders. If symptoms suggestive of aortic dissection, such as severe back pain, are observed, even after the end of pregnancy, exhaustive diagnostic examinations should be carried out.