Clinical Features of Pregnancy-Associated Aortic Dissection and Pregnancy Outcomes

Clinical Features of Pregnancy-Associated Aortic Dissection and Pregnancy Outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Features of Pregnancy-Associated Aortic Dissection and Pregnancy Outcomes Mengge Ke, Jingwen Yu, Li Li, Luyao Qian, Guangming Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7846542/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 Jan, 2026 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 12 You are reading this latest preprint version Abstract Background 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. Method Pregnant women and postpartum mothers with concomitant aortic dissection admitted to the Obstetrics Department of the First Affiliated Hospital of Zhengzhou University and the First Affiliated Hospital of Dali University between February 2012 and February 2025 over a 13-year period. 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. Thirty-three cases of acute aortic dissection were identified, comprising 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). Results Among the 33 patients, 29 (87.9%) underwent aortic repair surgery, including 14 cases of Type A aortic dissection (TAAD, 82.4%, 14/17) and 15 cases of Type B aortic dissection (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. Conclusion For pregnant women presenting with thoracolumbar pain and a high suspicion of aortic dissection, timely 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. Aortic dissection Pregnancy complications Cesarean section Infant mortality rate Gestational age Figures Figure 1 Figure 2 Figure 3 Background Aortic Dissection refers to the condition where blood enters the middle layer of the aortic wall through a tear in the inner lining, forming a dissecting hematoma. It is a rare and life-threatening disease, classified as an extremely critical aortic disorder [ 1 ]. Risk factors for Aortic Dissection primarily include structural abnormalities of the aortic wall (such as Marfan syndrome and atherosclerosis), increased aortic wall tension (such as hypertension and aortic coarctation), connective tissue diseases like systemic lupus erythematosus, and pregnancy [ 2 ]. Aortic dissection during pregnancy is even rarer, with an incidence rate of only 0.0004%. The condition progresses rapidly and is highly dangerous, often leading to the patient's death. Although rare, pregnancy-related aortic dissection is the third most common cause of maternal mortality due to cardiovascular disease [ 3 ]. The Stanford classification is the most commonly used method for categorizing aortic dissections in clinical practice: Dissections involving the ascending aorta are classified as Stanford Type A, while dissections confined to the thoracic descending aorta and its distal segments are classified as Stanford Type B [ 4 ]. In cases of aortic dissection during pregnancy, involvement of the ascending aorta is most common, specifically Stanford Type A, accounting for 79% of cases [ 5 ]. No matter what type of dissection, once ruptured aortic dissection, the condition is dangerous, the probability of successful rescue is extremely low, which seriously threatens the life of the mother and child. Therefore, early identification and whole process management are the key to reduce its mortality. However, there is currently no global consensus or guideline for the standardized management of aortic dissection during pregnancy. This study retrospectively analyzed the clinical data of 33 patients with aortic dissection during pregnancy to compare management strategies and clinical outcomes across different dissection subtypes.Clinical characteristics and pregnancy outcomes of patients undergoing simultaneous cardiac and cesarean section surgery versus those without simultaneous procedures, summarizing their clinical features and management experience. The objective is to enhance the ability of clinical healthcare providers to recognize and manage this condition early, thereby improving adverse maternal and fetal outcomes. Materials and Methods Patients Clinical data were collected from 33 pregnant women and postpartum mothers with concomitant aortic dissection during pregnancy and the puerperium admitted to the Department of Obstetrics at the First Affiliated Hospital of Zhengzhou University and the First Affiliated Hospital of Dali University over a 13-year period from February 2012 to February 2025(Patients with unclear age, gestational age, or perinatal and perioperative outcomes were excluded).Patients diagnosed with aortic dissection through transthoracic echocardiography (TTE), computed tomography angiography (CTA), or magnetic resonance angiography (MRA). The average age of these pregnant women was 32.27 years, with a median age of 32 ± 5.48 years (range: 23–43 years). The average gestational age at aortic dissection onset was 31 ± 6.99 weeks, with a median gestational age of 33 weeks and 2 days (range: 5 weeks of pregnancy to 1 month postpartum). Diagnostic Criteria and Classification According to the Stanford classification, type A aortic dissection refers to dissection occurring in the ascending aorta, with the primary tear located at the aortic root or within the ascending aorta. When ascending aortic dissection occurs but the primary tear originates in the aortic arch or descending aorta, it is termed retrograde type A thoracic aortic dissection [ 6 ]. Acute aortic dissection involving the descending aorta without (Stanford Type B or DeBakey Type IIIa) or with (Stanford Type B or DeBakey Type IIIb) abdominal aorta extension is classified as Type B thoracic aortic dissection. The ESC guidelines define complex type B thoracic aortic dissection as the presence of persistent or recurrent pain, drug-resistant hypertension, early aortic dilatation, signs of hypoperfusion or rupture, including hemothorax and increasing periaortic and mediastinal hematoma [ 7 ]. Diagnostic criteria for imaging primarily rely on imaging examinations such as transthoracic echocardiography (TTE), magnetic resonance angiography (MRA), and computed tomography angiography (CTA).Typical signs included tearing echoes of the inner membrane, two true and false lumen, and intimal tear in the lumen of the aorta [ 8 ]. Management Strategies Our management strategy determines the sequence of delivery versus aortic repair, or whether to perform simultaneous surgery, based on the type of aortic dissection and gestational age (Fig. 1 ). For patients with type A aortic dissection, in cases of pregnancy before 28 weeks, emergency surgical repair or termination of pregnancy is recommended under active fetal monitoring, based on the severity of the dissection and the decision of the patient and her family; For pregnancies beyond 28 weeks, we will perform an emergency cesarean section and concurrent aortic repair [ 9 ]. For patients with type B aortic dissection, our approach is to deliver the baby first, followed by surgical repair, endovascular repair, or medical management—unless urgent surgical repair is required due to inadequate perfusion, visceral ischemia, persistent pain, or impending aortic rupture [ 10 ]. Follow-up Follow-up of all survivors (mothers and fetuses or newborns) is primarily conducted through electronic medical record systems, outpatient visits, and telephone calls. Referring physicians document survival rates, postoperative complications, reoperations, adverse events, and infant growth and development. It is recommended that patients undergo an annual CT scan to evaluate the aorta and detect complications. Result Clinical Features Among 33 patients with aortic dissection, 17 cases (51.5%) were type A and 16 cases (48.5%) were type B. Only 1 case (3%) occurred during the first trimester, 9 cases (27.3%) during the second trimester, 19 cases (57.6%) during the third trimester, and 4 cases (12.1%) postpartum. 9 patients developed severe heart failure symptoms, classified according to the New York Heart Association (NYHA) functional classification: there were 7 cases of class Ⅲ (4 cases of type A, 3 cases of type B) and 2 cases of class Ⅳ (1 case of type A, 1 case of type B). Comorbidities: Marfan syndrome in 9 cases (27.3%), hypertension in 17 cases (51.5%), and acute myocardial infarction in 1 case (3%) (Table 1 ). Patients with Marfan syndrome were predominantly type A (88.9%, 8/9), while only one type B patient had Marfan syndrome (11.1%, 1/9). The mean age of these patients was 32.27 ± 5.48 years (type A: 31.53 ± 5.48 years; type B: 33.06 ± 5.56 years), with a mean gestational age of 31 ± 7 weeks (type A: 30 ± 8 weeks; type B: 32 ± 5 weeks). Table 1 Baseline patient profile Variables Aortic Dissection Type A Type B Total Patients 17(51.5%) 16(48.5%) 33(100%) Age (years), mean ± SD 31.53 ± 5.48 33.06 ± 5.56 32.27 ± 5.48 Marfan syndrome 8(47.1%) 1(6.3%) 9(27.3%) Hypertension 6(35.3%) 11(68.8%) 17(51.5%) Positive family history 0(0%) 1(6.3%) 1(3%) Aortic root diameter(mm) 47.35 ± 8.96 34 ± 4.32 40.88 ± 9.74 NYHA III 4(23.5%) 3(18.8%) 7(21.2%) NYHA IV 1(5.9%) 1(6.3%) 2(6%) Gestational age, weeks 30 ± 8 32 ± 5 31 ± 7 1st trimester 1(5.9%) 0(0%) 1(3%) 2nd trimester 3(17.6%) 6(37.5%) 9(27.3%) 3rd trimester 11(64.7%) 8(50%) 19(57.8%) Postpartum 2(11.8%) 2(12.5%) 4(12.1%) Treatment Among the 33 patients, 6 deaths occurred (18.2%), including 4 type A cases and 2 type B cases. A total of 29 patients (87.9%) underwent surgical repair, with 13 cases (39.4%) receiving composite graft root replacement (Bentall procedure), primarily in type A patients. Total aortic arch replacement with frozen elephant trunk (Sun's procedure) was performed in 10 cases (30.3%), all of which were conducted concurrently with the Bentall procedure. Endovascular isolation was performed in 16 cases (48.5%), left subclavian artery embolization in 1 case (3%). Concomitant cardiac procedures included aortic valve repair in 2 patients (6%) and coronary artery bypass grafting (CABG) in 2 patients (6%) (Table 2 )。 Type A aortic dissection Among the 17 patients with type A aortic dissection (Fig. 2 ), 1 was in early pregnancy, 3 were in mid-pregnancy, 11 were in late pregnancy, and 2 were in the puerperium. 13 cases (76.5%) underwent cesarean section, with a total of 4 deaths (23.5%). A case of sudden chest pain one month after amniocentesis-induced termination of pregnancy due to chronic hypertension complicated by severe preeclampsia resulted in death from aortic dissection rupture before surgical intervention could be performed; A 30-week pregnant woman experienced sudden chest pain and underwent an emergency lower segment cesarean section with B-Lynch suturing. She subsequently died from aortic rupture due to aortic dissection before aortic repair could be performed; One case presented with sudden chest pain at 24 weeks gestation accompanied by motor impairment in the left lower limb, the patient died due to ruptured aortic dissection before surgery could be performed. Another case involved a 38-week pregnant woman with acute myocardial infarction. Immediately upon admission, she underwent Bentall procedure combined with Sun's procedure, coronary artery bypass grafting, cesarean section, and total hysterectomy, one month postoperatively, the patient died from multiple organ failure. 14 cases (82.4%) underwent aortic repair surgery, including Bentall procedures in 12 patients (70.6%), endovascular exclusion in 2 patients (11.8%), and Sun's Procedure in 9 patients (52.9%). Among these, 2 patients underwent aortic valve repair and 2 underwent coronary artery bypass grafting (Table 2 )。10 of the 17 patients (58.8%) underwent cesarean section and aortic repair during the same stage (gestational weeks ranging from 27 to 38 GWs) (Fig. 3 ). Type B aortic dissection There were 16 patients with type B aortic dissection, including 6 in mid-pregnancy, 8 in late pregnancy, and 2 in the puerperium, among these, 15 cases (93.8%) underwent cesarean section (Table 2 ). Two deaths occurred (12.5% of Type B cases): A postpartum patient died two days after undergoing endovascular aortic repair due to recurrent aortic dissection rupture; another patient died from aortic dissection rupture 2 hours after spontaneous delivery outside the hospital, with no time for surgical intervention. 15 patients (93.8%) underwent aortic repair surgery, including one case (6.3%) who underwent Bentall-Sun's procedure at 28 weeks (pregnancy terminated via cesarean section at 32 weeks with both mother and infant in good health) and fourteen cases (70.6%) who underwent aortic endovascular exclusion(One case involved a 28-week-pregnant patient without complications who continued pregnancy after conservative management, pregnancy was terminated via cesarean section at 34 weeks, followed by intra-aortic occlusion on the 4th postpartum day, both mother and infant remained healthy. One case involved a patient who underwent endovascular aortic coiling at 26 weeks gestation and continued the pregnancy, with termination via cesarean section at 34 weeks. One case required endovascular aortic coiling combined with left subclavian artery embolization). Among the 16 patients, 5 (31.2%) underwent both cesarean section and aortic repair during the same stage (gestational weeks ranging from 31 to 38 GWs). Table 2 Data of surgical procedures Variables Aortic Dissection Type A Type B Total Patients 17(51.5%) 16(48.5%) 33(100%) Survival 13(76.5%) 14(87.5%) 27(81.8%) Death 4(23.5%) 2(12.5%) 6(18.2%) Cesarean section 13(76.5%) 15(93.8%) 28(84.8%) Natural birth 0(0%) 1(6.3%) 1(3%) Management strategies Surgical 14(82.4%) 15(93.8%) 29(87.9%) Endovascular 2(11.8%) 14(87.5%) 16(48.5%) Bentall Procedure a 12(70.6%) 1(6.3%) 13(39.4%) Sun's Procedure b 9(52.9%) 1(6.3%) 10(30.3%) Aortic valve repair 2(11.8%) 0(0%) 2(6%) coronary artery bypass grafting 2(11.8%) 0(0%) 2(6%) Embolization of the left subclavian artery 0(0%) 1(6.3%) 1(3%) Timing of aortic repair and delivery Delivery before aortic repair 3(17.6%) 5(31.3%) 8(24.2%) Aortic repair was performed at the same time as cesarean section 10(58.8) 5(31.3%) 15(45.5%) Aortic repair before delivery 3(17.6%) 5(31.3%) 8(24.2%) a: Composite Graft Aortic Root Replacement with Coronary Reimplantation b: Tetrafurcated Graft Total Aortic Arch Replacement with Frozen Elephant Trunk Table 3 Maternal and Infant outcomes Variables Aortic Dissection Type A(n = 17) Type B(n = 16) Total(n = 33) Maternal survival rate 76.5% (n = 13) 87.5% (n = 14) 81.8% (n = 27) Maternal mortality rate 23.5% (n = 4) 12.5% (n = 2) 18.2% (n = 6) Live birth newborn 70.6% (n = 12) 93.8% (n = 15) 81.8% (n = 27) Stillbirth 23.5% (n = 4) 12.5% (n = 2) 18.2% (n = 6) Induction of labor or abortion 17.6% (n = 3) 0% (n = 0) 9.1% (n = 3) Premature infants 52.9% (n = 9) 62.5% (n = 10) 57.6% (n = 19) Term birth 17.6% (n = 3) 31.3% (n = 5) 24.2% (n = 8) Neonatal outcomes (Death) 11.8% (n = 2) 0% (n = 0) 6% (n = 2) Weight of the newborn(kg) 2.3 ± 0.77 2.8 ± 0.71 2.6 ± 0.76 Neonatal survival rate 83.3% (n = 10) 100% (n = 15) 92.6% (n = 25) Fetal and Neonatal Outcomes A total of 27 cases (81.8%) of newborns survived delivery(Table 3 ), 12 cases of type A(70.6%, 12/17), 15 cases of type B(93.8%, 15/16), The live birth rate for Type A aortic dissection is lower than that for Type B. Among them, there were 8 full-term infants (24.2%, 3 with Type A, 5 with Type B) and 19 preterm infants (57.6%, 9 with Type A, 10 with Type B). Two neonatal deaths occurred, both in Type A aortic dissection cases (6%, 2/33). The neonatal mortality rate for type A aortic dissection (11.8%) is significantly higher than that for type B (0%). Both death infants were born at 29 weeks gestation, weighing 1210g and 1230g respectively. One was transferred to the NICU and died after unsuccessful resuscitation for pulmonary hemorrhage one day postpartum. The other was taken home by family members and later transferred to a local NICU, where it also died after unsuccessful resuscitation for pulmonary hemorrhage. Among patients with type A aortic dissection, there were 4 cases of intrauterine fetal death, including 3 cases of induced abortion and miscarriage. One case of induced abortion at 5 weeks of gestation; A Case of Fetal Death at 35 Weeks Gestation with Simultaneous Aortic Surgery and Cesarean Delivery for Fetal Removal; A 27-week pregnant woman underwent amniocentesis-induced termination due to “chronic hypertension complicated by severe preeclampsia and fetal diastolic blood flow reversal.” Among cases of type B aortic dissection, two fetuses experienced intrauterine death. One case underwent endovascular exclusion followed by cesarean delivery to remove the stillborn fetus. The other case experienced intrauterine fetal death two weeks after endovascular embolization and ultimately delivered vaginally. Discussion Aortic dissection during pregnancy is an extremely rare condition, with some patients dying before hospital admission, making the true incidence difficult to determine. Previous literature reports an incidence rate of approximately 14.5/ 100,000, with a maternal mortality rate as high as 30% [ 11 ]. Among the 33 hospitalized cases we collected, the maternal mortality rate for aortic dissection during pregnancy was 18.2%, with a mortality rate of 23.5% for type A dissection and 12.5% for type B dissection. If pregnant women do not receive systematic treatment, their risk of death increases significantly, with mortality rates rising by 1%–3% per hour. The 24-hour mortality rate reaches 25%, the one-week mortality rate reaches 70%, and the two-week mortality rate reaches 80% [ 12 ]. The most critical period in managing patients with aortic dissection begins with timely diagnosis, which requires a high index of clinical suspicion. Only by enhancing awareness of acute aortic dissection and improving the accuracy of initial diagnosis can adverse outcomes be avoided. Unfortunately, the initial misdiagnosis rate for aortic dissection remains high (38%-44%) [ 13 ], leading to increased morbidity. In the existing literature, only approximately 200 cases of aortic dissection during pregnancy have been reported. The rarity and limited experience with this complex condition make clinical diagnosis challenging and preclude the existence of detailed, specific management guidelines [ 14 ]. Therefore, we collected data on the etiology, management strategies, and clinical outcomes of 33 such patients over a 13-year period across two hospitals to report our experience. The risk of vascular events during pregnancy increases significantly compared to non-pregnant periods. Hormonal changes can affect the fundamental structure of the aortic wall. The placenta secretes large amounts of estrogen and progesterone that act on the aortic wall, reducing elastic fibers and increasing vascular wall fragility. This renders the aorta susceptible to tearing, leading to the formation of an aortic dissection [ 15 ]. During late pregnancy, blood volume increases significantly, and the impact force exerted by blood flow on the aortic wall also increases accordingly, leading to a higher risk of aortic dissection occurring in late pregnancy and the postpartum period. Increased aortic wall tension is more pronounced in women with hypertensive disorders of pregnancy [ 16 ], Hypertension was present in 76.6% of patients identified in the International Acute Aortic Dissection Registry [ 17 ], In this group of cases, 51.5% (17/33) of patients had concomitant hypertension at the time of onset. Women with underlying aortic wall structural abnormalities, combined with hemodynamic and vascular changes during pregnancy, are at increased risk for aortic dissection, particularly those with a family history of connective tissue disorders and aortic disease, especially individuals with Marfan syndrome [ 18 ]. In this cohort, 27.3% (9/33) of patients had concomitant Marfan syndrome. Therefore, for high-risk patients, it is advisable to undergo magnetic resonance imaging (MRI) to assess the entire aorta prior to conception. Patients with aortic root enlargement must undergo preconception evaluation and receive continuous aortic monitoring throughout pregnancy to reduce the risk of aortic dissection during gestation. Generally, patients with aortic root dilation of 4.0 cm to 4.5 cm, those with connective tissue disorders, those with a family history of aortic dissection, or those with indications for surgical aortic valve replacement should plan for surgery prior to pregnancy. Patients with a history of aortic dissection should avoid subsequent pregnancies[ 19 ]. All cases of Stanford Type A aortic dissection should undergo prompt surgical intervention to prevent life-threatening complications such as dissection rupture, which can lead to maternal and fetal mortality [ 20 ]. The primary concern in obstetrics is that extracorporeal circulation during aortic replacement surgery following cesarean section requires substantial anticoagulants, significantly increasing the risk of postpartum hemorrhage. Previous case reports document multiple instances where immediate total hysterectomy was performed after cesarean delivery to prevent major hemorrhage caused by anticoagulants [ 21 , 22 ]. In this study, 5 cases of type A aortic dissection underwent total hysterectomy during cesarean section, and the patients recovered well after surgery. However, considering the impact of organ resection on female fertility, we have also attempted surgical techniques such as intraoperative uterine packing with gauze strips and B-Lynch suturing, with patients experiencing good postoperative recovery. Similar cases have also been reported in recent years with favorable outcomes [ 23 ], therefore, it can be seen that preserving the uterus while employing effective hemostatic methods is also safe and reliable. For patients undergoing open vascular replacement surgery with plans to continue pregnancy, deep hypothermia has remained our preferred approach for open repair of chronic thoracic aortic dissection and thoracoabdominal aortic dissection in treating this complex pathology [ 24 ]. Abrupt termination of cold cycling may lead to fetal hypoxia and potential neurological abnormalities [ 25 ], however, shorter cycle-off periods contribute to a favorable prognosis for these patients [ 26 ]. One patient in this study underwent Bentall + Sun's procedure with moderate hypothermic cardiopulmonary bypass. After recovery and discharge, the patient continued the pregnancy. A cesarean section was performed at 2 months postoperatively to terminate the pregnancy. Follow-up revealed normal neonatal development with no neurological abnormalities. The primary surgical approach for treating Stanford Type B aortic dissection currently involves endovascular exclusion. For cases without bleeding or with unobstructed perfusion to major branches, conservative medical management may also be employed [ 27 ]. The first-line drug therapy is beta-blockers [ 28 ], which can control blood pressure, relieve pain, and slow the progression of aortic dissection. However, they may affect fetal development, leading to fetal bradycardia and growth restriction [ 29 ]. Recent studies suggest that early aortic repair within three months of onset is crucial for achieving complete aortic remodeling in patients with type B aortic dissection[ 30 ], though consensus has yet to be reached. In this study, 14 patients underwent endovascular exclusion. One patient died from recurrent aortic dissection rupture 2 days after the procedure, while the remaining 13 patients had favorable outcomes. Due to the small number of cases, current treatment experience remains limited to case reports, making it difficult to determine the optimal therapeutic approach. Recently, Martino et al. conducted a meta-analysis reporting maternal and fetal mortality rates of 23% and 27%, respectively, among pregnant women with aortic dissection during pregnancy and the puerperium. Among these cases, 67% were type A aortic dissections, significantly higher than type B dissections[ 31 ]. Our cohort also exhibited a higher percentage of fetal deaths in Type A aortic dissection, primarily because pregnancies in Type A patients typically occur at earlier gestational weeks. When pregnancy is terminated, the gestational age is smaller, making neonatal survival less likely. The intrauterine fetal death rate for Type A is also higher than that for Type B. Current clinical recommendations are based on a limited number of retrospective studies and case reports with low levels of evidence, highlighting the lack of robust evidence in this field. Conclusion In the treatment of pregnancy-associated aortic dissection, protecting both the mother and fetus is considered a hallmark of high-quality medical care—not solely pregnancy-centered, but rather an integrated approach aimed at enhancing maternal survival rates and fetal viability. However, preserving both the mother and fetus simultaneously remains a therapeutic challenge. Without timely and appropriate treatment, pregnancy-related aortic dissection carries a high risk of mortality for both the mother and fetus. For pregnant women presenting with chest or back pain and a high suspicion of aortic dissection, CTA should be performed promptly to avoid missed or delayed diagnosis. The optimal management strategy should be based on the dissection's anatomical type, gestational age, level of medical care available, and an overall assessment of fetal viability. Abbreviations TTE transthoracic echocardiography MRA magnetic resonance angiography CTA computed tomography angiography NICU neonatal intensive care unit Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of the First Affiliated Hospital of Dali University. All procedures were performed under the relevant guidelines and regulations. Written informed consent for participation in this study and accompanying images was obtained from the patient. Consent for publication Written informed consent was obtained from the patient for publication. There are no identifying images or other personal or clinical details of the patient that compromise her anonymity in this manuscript. Availability of data and materials The data sets used and/or analyzed in this study are available from the corresponding author upon reasonable request. Competing interests The authors declare no competing interests. Funding This work was supported by the key construction disciplines of The First Affiliated Hospital of Dali University. Authors’ contributions MGK and JWY: Conceptualization, Writing-Original Draft, Summary of cases. MGK and JWY contributed equally to this article. LL revised treatment and outcomes, and LYQ interpreted imaging images. GMW: Writing -Review & Editing, Funding acquisition. All authors read and approve the final manuscript. Acknowledgements Not applicable. References Mussa FF, Horton JD, Moridzadeh R, Nicholson J, Trimarchi S, Eagle KA: Acute Aortic Dissection and Intramural Hematoma: A Systematic Review . Jama 2016, 316 (7):754-763. Fukui T: Management of acute aortic dissection and thoracic aortic rupture . J Intensive Care 2018, 6 :15. 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Int J Obstet Anesth 2014, 23 (4):348-356. Samanidis G, Kanakis M, Kolovou K, Perreas K: Does deep hypothermic circulatory arrest with versus without retrograde cerebral perfusion affect the outcomes after proximal aortic arch aneurysm and acute type A aortic dissection repair? Different pathologies and cerebral protection techniques with similar results . J Card Surg 2022, 37 (10):3287-3289. Weissler EH, Osazuwa-Peters OL, Greiner MA, Hardy NC, Kougias P, O'Brien SM, Mark DB, Jones WS, Secemsky EA, Vekstein AM et al : Initial Thoracic Endovascular Aortic Repair vs Medical Therapy for Acute Uncomplicated Type B Aortic Dissection . JAMA Cardiol 2023, 8 (1):44-53. KK C, P L, JM W: First-line beta-blockers versus other antihypertensive medications for chronic type B aortic dissection . The Cochrane database of systematic reviews 2014, null (2):CD010426. Expert consensus document on management of cardiovascular diseases during pregnancy . Eur Heart J 2003, 24 (8):761-781. Reutersberg B, Meuli L: Early, Late, or Never? The Unresolved Timing of Thoracic Endovascular Aortic Repair in Type B Aortic Dissection? Eur J Vasc Endovasc Surg 2025, null . De Martino A, Morganti R, Falcetta G, Scioti G, Milano AD, Pucci A, Bortolotti U: Acute aortic dissection and pregnancy: Review and meta-analysis of incidence, presentation, and pathologic substrates . J Card Surg 2019, 34 (12):1591-1597. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 31 Jan, 2026 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted Editorial decision: Revision requested 17 Nov, 2025 Reviews received at journal 12 Nov, 2025 Reviewers agreed at journal 11 Nov, 2025 Reviews received at journal 06 Nov, 2025 Reviewers agreed at journal 27 Oct, 2025 Reviews received at journal 26 Oct, 2025 Reviewers agreed at journal 25 Oct, 2025 Reviewers invited by journal 23 Oct, 2025 Editor invited by journal 15 Oct, 2025 Editor assigned by journal 13 Oct, 2025 Submission checks completed at journal 13 Oct, 2025 First submitted to journal 13 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7846542","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":538673818,"identity":"5ccecaf1-116f-4c91-a7b6-dacb13e79ffa","order_by":0,"name":"Mengge Ke","email":"","orcid":"","institution":"The First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"Mengge","middleName":"","lastName":"Ke","suffix":""},{"id":538673819,"identity":"e5aefec7-e14b-45f2-aea5-7319ec04b091","order_by":1,"name":"Jingwen Yu","email":"","orcid":"","institution":"The First Affiliated Hospital of Dali University","correspondingAuthor":false,"prefix":"","firstName":"Jingwen","middleName":"","lastName":"Yu","suffix":""},{"id":538673820,"identity":"8bfa930a-8cf9-4e24-99dc-d0796a3151d0","order_by":2,"name":"Li Li","email":"","orcid":"","institution":"The First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Li","suffix":""},{"id":538673821,"identity":"f0cfce81-fcda-44dc-a1b5-e40e2c13f7b6","order_by":3,"name":"Luyao Qian","email":"","orcid":"","institution":"Dancheng County People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Luyao","middleName":"","lastName":"Qian","suffix":""},{"id":538673822,"identity":"c0514cc4-496b-4171-aabf-5f7c854d5633","order_by":4,"name":"Guangming Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYJCCAx8qJOQYDjA3HGBgYCZKB+PBGWcsjBkOMBKvhfkwb1tFYgNQCwNRWgzOr04AapFI7zt+sPEAQ4V1YgP72QP4tdx4u+HgnHMSuTPPAC1iOJOe2MCTl4BXi9mNsxsOvCmTyN1wAOS2tsOJDRI8BoS18LBJpBucfwjU8o8YLed7NxzkaZNIMLgBDgEitNjf4N0ADGQJw5k3gLYkHEs3buPJwa9Fsv/s5g8fKurk+c4nH/7wocZatp/9DH4tDBIJSBwQmw2/eiDgP0BQySgYBaNgFIx0AAAJtVhQqyoy8QAAAABJRU5ErkJggg==","orcid":"","institution":"The First Affiliated Hospital of Dali University","correspondingAuthor":true,"prefix":"","firstName":"Guangming","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-10-13 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13:40:55","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":105845,"visible":true,"origin":"","legend":"","description":"","filename":"c86fc9095fa9415fa24ceae7fe7a991a1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7846542/v1/2ce7047df6e35dc614d32119.xml"},{"id":95119190,"identity":"682e151c-8294-413b-a094-e97adef19424","added_by":"auto","created_at":"2025-11-04 13:40:55","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":111266,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7846542/v1/eb8addd69c47d712e87ad332.html"},{"id":95224320,"identity":"b5627d2e-7219-4caa-a650-e49c93f7d8a7","added_by":"auto","created_at":"2025-11-05 16:23:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":150882,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of Management Strategies for Aortic Dissection During Pregnancy and the Postpartum Period.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7846542/v1/fd0ca48324637ec4963c7a59.png"},{"id":95225866,"identity":"86ffae2c-60a9-411d-970d-91f05482ad2e","added_by":"auto","created_at":"2025-11-05 16:25:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":289956,"visible":true,"origin":"","legend":"\u003cp\u003eAxial computed tomography images of a 40-year-old woman with acute type A aortic dissection at 31 weeks of gestation, located at the levels of (A) the brachiocephalic trunk, (B) the aortic arch, (C) the ascending aorta, and (D) the iliac bifurcation.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7846542/v1/6b339bc32914ad724da5cf9e.png"},{"id":95119180,"identity":"46e6d10d-bc85-48ba-aaaf-f6a605d4cd35","added_by":"auto","created_at":"2025-11-04 13:40:55","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":337749,"visible":true,"origin":"","legend":"\u003cp\u003eSagittal reconstruction CT image (left) of a 40-year-old woman with polycystic ovary syndrome presenting with acute type A aortic dissection at 31 weeks gestation. Maternal and fetal survival were achieved via cesarean section, followed by composite root and total arch replacement using the Bentall+Sun's procedure. CT scan at 2 months postoperatively (right).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7846542/v1/2179d23510f9e0d3a6992c9d.png"},{"id":101691902,"identity":"99895c41-a831-4b4b-a1da-d222518ebed1","added_by":"auto","created_at":"2026-02-02 16:16:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3009596,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7846542/v1/66915bb7-4dd9-4154-9a51-42431b9d1795.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Features of Pregnancy-Associated Aortic Dissection and Pregnancy Outcomes","fulltext":[{"header":"Background","content":"\u003cp\u003eAortic Dissection refers to the condition where blood enters the middle layer of the aortic wall through a tear in the inner lining, forming a dissecting hematoma. It is a rare and life-threatening disease, classified as an extremely critical aortic disorder [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Risk factors for Aortic Dissection primarily include structural abnormalities of the aortic wall (such as Marfan syndrome and atherosclerosis), increased aortic wall tension (such as hypertension and aortic coarctation), connective tissue diseases like systemic lupus erythematosus, and pregnancy [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAortic dissection during pregnancy is even rarer, with an incidence rate of only 0.0004%. The condition progresses rapidly and is highly dangerous, often leading to the patient's death. Although rare, pregnancy-related aortic dissection is the third most common cause of maternal mortality due to cardiovascular disease [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The Stanford classification is the most commonly used method for categorizing aortic dissections in clinical practice: Dissections involving the ascending aorta are classified as Stanford Type A, while dissections confined to the thoracic descending aorta and its distal segments are classified as Stanford Type B [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In cases of aortic dissection during pregnancy, involvement of the ascending aorta is most common, specifically Stanford Type A, accounting for 79% of cases [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. No matter what type of dissection, once ruptured aortic dissection, the condition is dangerous, the probability of successful rescue is extremely low, which seriously threatens the life of the mother and child. Therefore, early identification and whole process management are the key to reduce its mortality.\u003c/p\u003e\u003cp\u003eHowever, there is currently no global consensus or guideline for the standardized management of aortic dissection during pregnancy. This study retrospectively analyzed the clinical data of 33 patients with aortic dissection during pregnancy to compare management strategies and clinical outcomes across different dissection subtypes.Clinical characteristics and pregnancy outcomes of patients undergoing simultaneous cardiac and cesarean section surgery versus those without simultaneous procedures, summarizing their clinical features and management experience. The objective is to enhance the ability of clinical healthcare providers to recognize and manage this condition early, thereby improving adverse maternal and fetal outcomes.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatients\u003c/h2\u003e\u003cp\u003eClinical data were collected from 33 pregnant women and postpartum mothers with concomitant aortic dissection during pregnancy and the puerperium admitted to the Department of Obstetrics at the First Affiliated Hospital of Zhengzhou University and the First Affiliated Hospital of Dali University over a 13-year period from February 2012 to February 2025(Patients with unclear age, gestational age, or perinatal and perioperative outcomes were excluded).Patients diagnosed with aortic dissection through transthoracic echocardiography (TTE), computed tomography angiography (CTA), or magnetic resonance angiography (MRA). The average age of these pregnant women was 32.27 years, with a median age of 32\u0026thinsp;\u0026plusmn;\u0026thinsp;5.48 years (range: 23\u0026ndash;43 years). The average gestational age at aortic dissection onset was 31\u0026thinsp;\u0026plusmn;\u0026thinsp;6.99 weeks, with a median gestational age of 33 weeks and 2 days (range: 5 weeks of pregnancy to 1 month postpartum).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eDiagnostic Criteria and Classification\u003c/h3\u003e\n\u003cp\u003eAccording to the Stanford classification, type A aortic dissection refers to dissection occurring in the ascending aorta, with the primary tear located at the aortic root or within the ascending aorta. When ascending aortic dissection occurs but the primary tear originates in the aortic arch or descending aorta, it is termed retrograde type A thoracic aortic dissection [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Acute aortic dissection involving the descending aorta without (Stanford Type B or DeBakey Type IIIa) or with (Stanford Type B or DeBakey Type IIIb) abdominal aorta extension is classified as Type B thoracic aortic dissection. The ESC guidelines define complex type B thoracic aortic dissection as the presence of persistent or recurrent pain, drug-resistant hypertension, early aortic dilatation, signs of hypoperfusion or rupture, including hemothorax and increasing periaortic and mediastinal hematoma [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Diagnostic criteria for imaging primarily rely on imaging examinations such as transthoracic echocardiography (TTE), magnetic resonance angiography (MRA), and computed tomography angiography (CTA).Typical signs included tearing echoes of the inner membrane, two true and false lumen, and intimal tear in the lumen of the aorta [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eManagement Strategies\u003c/h3\u003e\n\u003cp\u003eOur management strategy determines the sequence of delivery versus aortic repair, or whether to perform simultaneous surgery, based on the type of aortic dissection and gestational age (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). For patients with type A aortic dissection, in cases of pregnancy before 28 weeks, emergency surgical repair or termination of pregnancy is recommended under active fetal monitoring, based on the severity of the dissection and the decision of the patient and her family; For pregnancies beyond 28 weeks, we will perform an emergency cesarean section and concurrent aortic repair [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. For patients with type B aortic dissection, our approach is to deliver the baby first, followed by surgical repair, endovascular repair, or medical management\u0026mdash;unless urgent surgical repair is required due to inadequate perfusion, visceral ischemia, persistent pain, or impending aortic rupture [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eFollow-up\u003c/h3\u003e\n\u003cp\u003eFollow-up of all survivors (mothers and fetuses or newborns) is primarily conducted through electronic medical record systems, outpatient visits, and telephone calls. Referring physicians document survival rates, postoperative complications, reoperations, adverse events, and infant growth and development. It is recommended that patients undergo an annual CT scan to evaluate the aorta and detect complications.\u003c/p\u003e"},{"header":"Result","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eClinical Features\u003c/h2\u003e\u003cp\u003eAmong 33 patients with aortic dissection, 17 cases (51.5%) were type A and 16 cases (48.5%) were type B. Only 1 case (3%) occurred during the first trimester, 9 cases (27.3%) during the second trimester, 19 cases (57.6%) during the third trimester, and 4 cases (12.1%) postpartum. 9 patients developed severe heart failure symptoms, classified according to the New York Heart Association (NYHA) functional classification: there were 7 cases of class Ⅲ (4 cases of type A, 3 cases of type B) and 2 cases of class Ⅳ (1 case of type A, 1 case of type B). Comorbidities: Marfan syndrome in 9 cases (27.3%), hypertension in 17 cases (51.5%), and acute myocardial infarction in 1 case (3%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Patients with Marfan syndrome were predominantly type A (88.9%, 8/9), while only one type B patient had Marfan syndrome (11.1%, 1/9). The mean age of these patients was 32.27\u0026thinsp;\u0026plusmn;\u0026thinsp;5.48 years (type A: 31.53\u0026thinsp;\u0026plusmn;\u0026thinsp;5.48 years; type B: 33.06\u0026thinsp;\u0026plusmn;\u0026thinsp;5.56 years), with a mean gestational age of 31\u0026thinsp;\u0026plusmn;\u0026thinsp;7 weeks (type A: 30\u0026thinsp;\u0026plusmn;\u0026thinsp;8 weeks; type B: 32\u0026thinsp;\u0026plusmn;\u0026thinsp;5 weeks).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline patient profile\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eAortic Dissection\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eType A\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eType B\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17(51.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(48.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31.53\u0026thinsp;\u0026plusmn;\u0026thinsp;5.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.06\u0026thinsp;\u0026plusmn;\u0026thinsp;5.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.27\u0026thinsp;\u0026plusmn;\u0026thinsp;5.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarfan syndrome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(47.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(6.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9(27.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6(35.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11(68.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17(51.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive family history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(6.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAortic root diameter(mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47.35\u0026thinsp;\u0026plusmn;\u0026thinsp;8.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34\u0026thinsp;\u0026plusmn;\u0026thinsp;4.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40.88\u0026thinsp;\u0026plusmn;\u0026thinsp;9.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNYHA III\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(23.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(18.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(21.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNYHA IV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(5.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(6.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational age, weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u0026thinsp;\u0026plusmn;\u0026thinsp;8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1st trimester\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(5.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2nd trimester\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3(17.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(37.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9(27.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3rd trimester\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11(64.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19(57.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostpartum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2(11.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(12.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(12.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eTreatment\u003c/h3\u003e\n\u003cp\u003eAmong the 33 patients, 6 deaths occurred (18.2%), including 4 type A cases and 2 type B cases. A total of 29 patients (87.9%) underwent surgical repair, with 13 cases (39.4%) receiving composite graft root replacement (Bentall procedure), primarily in type A patients. Total aortic arch replacement with frozen elephant trunk (Sun's procedure) was performed in 10 cases (30.3%), all of which were conducted concurrently with the Bentall procedure. Endovascular isolation was performed in 16 cases (48.5%), left subclavian artery embolization in 1 case (3%). Concomitant cardiac procedures included aortic valve repair in 2 patients (6%) and coronary artery bypass grafting (CABG) in 2 patients (6%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)。\u003c/p\u003e\n\u003ch3\u003eType A aortic dissection\u003c/h3\u003e\n\u003cp\u003eAmong the 17 patients with type A aortic dissection (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), 1 was in early pregnancy, 3 were in mid-pregnancy, 11 were in late pregnancy, and 2 were in the puerperium. 13 cases (76.5%) underwent cesarean section, with a total of 4 deaths (23.5%). A case of sudden chest pain one month after amniocentesis-induced termination of pregnancy due to chronic hypertension complicated by severe preeclampsia resulted in death from aortic dissection rupture before surgical intervention could be performed; A 30-week pregnant woman experienced sudden chest pain and underwent an emergency lower segment cesarean section with B-Lynch suturing. She subsequently died from aortic rupture due to aortic dissection before aortic repair could be performed; One case presented with sudden chest pain at 24 weeks gestation accompanied by motor impairment in the left lower limb, the patient died due to ruptured aortic dissection before surgery could be performed. Another case involved a 38-week pregnant woman with acute myocardial infarction. Immediately upon admission, she underwent Bentall procedure combined with Sun's procedure, coronary artery bypass grafting, cesarean section, and total hysterectomy, one month postoperatively, the patient died from multiple organ failure.\u003c/p\u003e\u003cp\u003e14 cases (82.4%) underwent aortic repair surgery, including Bentall procedures in 12 patients (70.6%), endovascular exclusion in 2 patients (11.8%), and Sun's Procedure in 9 patients (52.9%). Among these, 2 patients underwent aortic valve repair and 2 underwent coronary artery bypass grafting (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)。10 of the 17 patients (58.8%) underwent cesarean section and aortic repair during the same stage (gestational weeks ranging from 27 to 38 GWs) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eType B aortic dissection\u003c/h2\u003e\u003cp\u003eThere were 16 patients with type B aortic dissection, including 6 in mid-pregnancy, 8 in late pregnancy, and 2 in the puerperium, among these, 15 cases (93.8%) underwent cesarean section (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Two deaths occurred (12.5% of Type B cases): A postpartum patient died two days after undergoing endovascular aortic repair due to recurrent aortic dissection rupture; another patient died from aortic dissection rupture 2 hours after spontaneous delivery outside the hospital, with no time for surgical intervention. 15 patients (93.8%) underwent aortic repair surgery, including one case (6.3%) who underwent Bentall-Sun's procedure at 28 weeks (pregnancy terminated via cesarean section at 32 weeks with both mother and infant in good health) and fourteen cases (70.6%) who underwent aortic endovascular exclusion(One case involved a 28-week-pregnant patient without complications who continued pregnancy after conservative management, pregnancy was terminated via cesarean section at 34 weeks, followed by intra-aortic occlusion on the 4th postpartum day, both mother and infant remained healthy. One case involved a patient who underwent endovascular aortic coiling at 26 weeks gestation and continued the pregnancy, with termination via cesarean section at 34 weeks. One case required endovascular aortic coiling combined with left subclavian artery embolization). Among the 16 patients, 5 (31.2%) underwent both cesarean section and aortic repair during the same stage (gestational weeks ranging from 31 to 38 GWs).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eData of surgical procedures\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eAortic Dissection\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eType A\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eType B\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17(51.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(48.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurvival\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13(76.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14(87.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27(81.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeath\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(23.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(12.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6(18.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCesarean section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13(76.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15(93.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28(84.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNatural birth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(6.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eManagement strategies\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14(82.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15(93.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29(87.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEndovascular\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2(11.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14(87.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(48.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBentall Procedure\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12(70.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(6.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13(39.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSun's Procedure\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9(52.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(6.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10(30.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAortic valve repair\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2(11.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ecoronary artery bypass grafting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2(11.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmbolization of the left subclavian artery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(6.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTiming of aortic repair and delivery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDelivery before aortic repair\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3(17.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(31.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8(24.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAortic repair was performed at the same time as cesarean section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10(58.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(31.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15(45.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAortic repair before delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3(17.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(31.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8(24.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ea: Composite Graft Aortic Root Replacement with Coronary Reimplantation\u003c/p\u003e\u003cp\u003eb: Tetrafurcated Graft Total Aortic Arch Replacement with Frozen Elephant Trunk\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMaternal and Infant outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eAortic Dissection\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eType A(n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eType B(n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal(n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal survival rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e76.5% (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e87.5% (n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81.8% (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal mortality rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.5% (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.5% (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18.2% (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLive birth newborn\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70.6% (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93.8% (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81.8% (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStillbirth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.5% (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.5% (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18.2% (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInduction of labor or abortion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17.6% (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0% (n\u0026thinsp;=\u0026thinsp;0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.1% (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePremature infants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52.9% (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.5% (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57.6% (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTerm birth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17.6% (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.3% (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24.2% (n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeonatal outcomes (Death)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.8% (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0% (n\u0026thinsp;=\u0026thinsp;0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6% (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight of the newborn(kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeonatal survival rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83.3% (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100% (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92.6% (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eFetal and Neonatal Outcomes\u003c/h2\u003e\u003cp\u003eA total of 27 cases (81.8%) of newborns survived delivery(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), 12 cases of type A(70.6%, 12/17), 15 cases of type B(93.8%, 15/16), The live birth rate for Type A aortic dissection is lower than that for Type B. Among them, there were 8 full-term infants (24.2%, 3 with Type A, 5 with Type B) and 19 preterm infants (57.6%, 9 with Type A, 10 with Type B). Two neonatal deaths occurred, both in Type A aortic dissection cases (6%, 2/33). The neonatal mortality rate for type A aortic dissection (11.8%) is significantly higher than that for type B (0%). Both death infants were born at 29 weeks gestation, weighing 1210g and 1230g respectively. One was transferred to the NICU and died after unsuccessful resuscitation for pulmonary hemorrhage one day postpartum. The other was taken home by family members and later transferred to a local NICU, where it also died after unsuccessful resuscitation for pulmonary hemorrhage.\u003c/p\u003e\u003cp\u003eAmong patients with type A aortic dissection, there were 4 cases of intrauterine fetal death, including 3 cases of induced abortion and miscarriage. One case of induced abortion at 5 weeks of gestation; A Case of Fetal Death at 35 Weeks Gestation with Simultaneous Aortic Surgery and Cesarean Delivery for Fetal Removal; A 27-week pregnant woman underwent amniocentesis-induced termination due to \u0026ldquo;chronic hypertension complicated by severe preeclampsia and fetal diastolic blood flow reversal.\u0026rdquo; Among cases of type B aortic dissection, two fetuses experienced intrauterine death. One case underwent endovascular exclusion followed by cesarean delivery to remove the stillborn fetus. The other case experienced intrauterine fetal death two weeks after endovascular embolization and ultimately delivered vaginally.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAortic dissection during pregnancy is an extremely rare condition, with some patients dying before hospital admission, making the true incidence difficult to determine. Previous literature reports an incidence rate of approximately 14.5/ 100,000, with a maternal mortality rate as high as 30% [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Among the 33 hospitalized cases we collected, the maternal mortality rate for aortic dissection during pregnancy was 18.2%, with a mortality rate of 23.5% for type A dissection and 12.5% for type B dissection. If pregnant women do not receive systematic treatment, their risk of death increases significantly, with mortality rates rising by 1%\u0026ndash;3% per hour. The 24-hour mortality rate reaches 25%, the one-week mortality rate reaches 70%, and the two-week mortality rate reaches 80% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The most critical period in managing patients with aortic dissection begins with timely diagnosis, which requires a high index of clinical suspicion. Only by enhancing awareness of acute aortic dissection and improving the accuracy of initial diagnosis can adverse outcomes be avoided. Unfortunately, the initial misdiagnosis rate for aortic dissection remains high (38%-44%) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], leading to increased morbidity. In the existing literature, only approximately 200 cases of aortic dissection during pregnancy have been reported. The rarity and limited experience with this complex condition make clinical diagnosis challenging and preclude the existence of detailed, specific management guidelines [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Therefore, we collected data on the etiology, management strategies, and clinical outcomes of 33 such patients over a 13-year period across two hospitals to report our experience.\u003c/p\u003e\u003cp\u003eThe risk of vascular events during pregnancy increases significantly compared to non-pregnant periods. Hormonal changes can affect the fundamental structure of the aortic wall. The placenta secretes large amounts of estrogen and progesterone that act on the aortic wall, reducing elastic fibers and increasing vascular wall fragility. This renders the aorta susceptible to tearing, leading to the formation of an aortic dissection [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. During late pregnancy, blood volume increases significantly, and the impact force exerted by blood flow on the aortic wall also increases accordingly, leading to a higher risk of aortic dissection occurring in late pregnancy and the postpartum period. Increased aortic wall tension is more pronounced in women with hypertensive disorders of pregnancy [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], Hypertension was present in 76.6% of patients identified in the International Acute Aortic Dissection Registry [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], In this group of cases, 51.5% (17/33) of patients had concomitant hypertension at the time of onset. Women with underlying aortic wall structural abnormalities, combined with hemodynamic and vascular changes during pregnancy, are at increased risk for aortic dissection, particularly those with a family history of connective tissue disorders and aortic disease, especially individuals with Marfan syndrome [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In this cohort, 27.3% (9/33) of patients had concomitant Marfan syndrome. Therefore, for high-risk patients, it is advisable to undergo magnetic resonance imaging (MRI) to assess the entire aorta prior to conception. Patients with aortic root enlargement must undergo preconception evaluation and receive continuous aortic monitoring throughout pregnancy to reduce the risk of aortic dissection during gestation. Generally, patients with aortic root dilation of 4.0 cm to 4.5 cm, those with connective tissue disorders, those with a family history of aortic dissection, or those with indications for surgical aortic valve replacement should plan for surgery prior to pregnancy. Patients with a history of aortic dissection should avoid subsequent pregnancies[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAll cases of Stanford Type A aortic dissection should undergo prompt surgical intervention to prevent life-threatening complications such as dissection rupture, which can lead to maternal and fetal mortality [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The primary concern in obstetrics is that extracorporeal circulation during aortic replacement surgery following cesarean section requires substantial anticoagulants, significantly increasing the risk of postpartum hemorrhage. Previous case reports document multiple instances where immediate total hysterectomy was performed after cesarean delivery to prevent major hemorrhage caused by anticoagulants [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In this study, 5 cases of type A aortic dissection underwent total hysterectomy during cesarean section, and the patients recovered well after surgery. However, considering the impact of organ resection on female fertility, we have also attempted surgical techniques such as intraoperative uterine packing with gauze strips and B-Lynch suturing, with patients experiencing good postoperative recovery. Similar cases have also been reported in recent years with favorable outcomes [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], therefore, it can be seen that preserving the uterus while employing effective hemostatic methods is also safe and reliable. For patients undergoing open vascular replacement surgery with plans to continue pregnancy, deep hypothermia has remained our preferred approach for open repair of chronic thoracic aortic dissection and thoracoabdominal aortic dissection in treating this complex pathology [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Abrupt termination of cold cycling may lead to fetal hypoxia and potential neurological abnormalities [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], however, shorter cycle-off periods contribute to a favorable prognosis for these patients [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. One patient in this study underwent Bentall\u0026thinsp;+\u0026thinsp;Sun's procedure with moderate hypothermic cardiopulmonary bypass. After recovery and discharge, the patient continued the pregnancy. A cesarean section was performed at 2 months postoperatively to terminate the pregnancy. Follow-up revealed normal neonatal development with no neurological abnormalities.\u003c/p\u003e\u003cp\u003eThe primary surgical approach for treating Stanford Type B aortic dissection currently involves endovascular exclusion. For cases without bleeding or with unobstructed perfusion to major branches, conservative medical management may also be employed [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The first-line drug therapy is beta-blockers [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], which can control blood pressure, relieve pain, and slow the progression of aortic dissection. However, they may affect fetal development, leading to fetal bradycardia and growth restriction [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Recent studies suggest that early aortic repair within three months of onset is crucial for achieving complete aortic remodeling in patients with type B aortic dissection[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], though consensus has yet to be reached. In this study, 14 patients underwent endovascular exclusion. One patient died from recurrent aortic dissection rupture 2 days after the procedure, while the remaining 13 patients had favorable outcomes. Due to the small number of cases, current treatment experience remains limited to case reports, making it difficult to determine the optimal therapeutic approach.\u003c/p\u003e\u003cp\u003eRecently, Martino et al. conducted a meta-analysis reporting maternal and fetal mortality rates of 23% and 27%, respectively, among pregnant women with aortic dissection during pregnancy and the puerperium. Among these cases, 67% were type A aortic dissections, significantly higher than type B dissections[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Our cohort also exhibited a higher percentage of fetal deaths in Type A aortic dissection, primarily because pregnancies in Type A patients typically occur at earlier gestational weeks. When pregnancy is terminated, the gestational age is smaller, making neonatal survival less likely. The intrauterine fetal death rate for Type A is also higher than that for Type B. Current clinical recommendations are based on a limited number of retrospective studies and case reports with low levels of evidence, highlighting the lack of robust evidence in this field.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn the treatment of pregnancy-associated aortic dissection, protecting both the mother and fetus is considered a hallmark of high-quality medical care\u0026mdash;not solely pregnancy-centered, but rather an integrated approach aimed at enhancing maternal survival rates and fetal viability. However, preserving both the mother and fetus simultaneously remains a therapeutic challenge. Without timely and appropriate treatment, pregnancy-related aortic dissection carries a high risk of mortality for both the mother and fetus. For pregnant women presenting with chest or back pain and a high suspicion of aortic dissection, CTA should be performed promptly to avoid missed or delayed diagnosis. The optimal management strategy should be based on the dissection's anatomical type, gestational age, level of medical care available, and an overall assessment of fetal viability.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eTTE \u0026nbsp; \u0026nbsp; transthoracic echocardiography\u003c/p\u003e\n\u003cp\u003eMRA \u0026nbsp; \u0026nbsp;magnetic resonance angiography\u003c/p\u003e\n\u003cp\u003eCTA \u0026nbsp; \u0026nbsp; computed tomography angiography\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNICU \u0026nbsp; \u0026nbsp;neonatal intensive care unit\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the First Affiliated Hospital of Dali University. All procedures were performed under the relevant guidelines and regulations. Written informed consent for participation in this study and accompanying images was obtained from the patient. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication. There are no identifying images or other personal or clinical details of the patient that compromise her anonymity in this manuscript.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sets used and/or analyzed in this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the key construction disciplines of The First Affiliated Hospital of Dali University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMGK and JWY: Conceptualization, Writing-Original Draft, Summary of cases. MGK and JWY contributed equally to this article.\u0026nbsp;LL revised treatment and outcomes, and LYQ interpreted imaging images. GMW: Writing -Review \u0026amp; Editing, Funding acquisition. All authors read and approve the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMussa FF, Horton JD, Moridzadeh R, Nicholson J, Trimarchi S, Eagle KA: \u003cstrong\u003eAcute Aortic Dissection and Intramural Hematoma: A Systematic Review\u003c/strong\u003e. \u003cem\u003eJama\u0026nbsp;\u003c/em\u003e2016, \u003cstrong\u003e316\u003c/strong\u003e(7):754-763.\u003c/li\u003e\n \u003cli\u003eFukui T: \u003cstrong\u003eManagement of acute aortic dissection and thoracic aortic rupture\u003c/strong\u003e. \u003cem\u003eJ Intensive Care\u0026nbsp;\u003c/em\u003e2018, \u003cstrong\u003e6\u003c/strong\u003e:15.\u003c/li\u003e\n \u003cli\u003eMa WG, Zhu JM, Chen Y, Qiao ZY, Ge YP, Li CN, Zheng J, Liu YM, Sun LZ: \u003cstrong\u003eAortic dissection during pregnancy and postpartum in patients with Marfan syndrome: a 21-year clinical experience in 30 patients\u003c/strong\u003e. \u003cem\u003eEur J Cardiothorac Surg\u0026nbsp;\u003c/em\u003e2020, \u003cstrong\u003e58\u003c/strong\u003e(2):294-301.\u003c/li\u003e\n \u003cli\u003eGe YY, Rong D, Ge XH, Miao JH, Fan WD, Liu XP, Guo W: \u003cstrong\u003eThe 301 Classification: A Proposed Modification to the Stanford Type B Aortic Dissection Classification for Thoracic Endovascular Aortic Repair Prognostication\u003c/strong\u003e. \u003cem\u003eMayo Clin Proc\u0026nbsp;\u003c/em\u003e2020, \u003cstrong\u003e95\u003c/strong\u003e(7):1329-1341.\u003c/li\u003e\n \u003cli\u003eCantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, Harper A, Hulbert D, Lucas S, McClure J\u003cem\u003e\u0026nbsp;et al\u003c/em\u003e: \u003cstrong\u003eSaving Mothers\u0026apos; Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. 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Different pathologies and cerebral protection techniques with similar results\u003c/strong\u003e. \u003cem\u003eJ Card Surg\u0026nbsp;\u003c/em\u003e2022, \u003cstrong\u003e37\u003c/strong\u003e(10):3287-3289.\u003c/li\u003e\n \u003cli\u003eWeissler EH, Osazuwa-Peters OL, Greiner MA, Hardy NC, Kougias P, O\u0026apos;Brien SM, Mark DB, Jones WS, Secemsky EA, Vekstein AM\u003cem\u003e\u0026nbsp;et al\u003c/em\u003e: \u003cstrong\u003eInitial Thoracic Endovascular Aortic Repair vs Medical Therapy for Acute Uncomplicated Type B Aortic Dissection\u003c/strong\u003e. \u003cem\u003eJAMA Cardiol\u0026nbsp;\u003c/em\u003e2023, \u003cstrong\u003e8\u003c/strong\u003e(1):44-53.\u003c/li\u003e\n \u003cli\u003eKK C, P L, JM W: \u003cstrong\u003eFirst-line beta-blockers versus other antihypertensive medications for chronic type B aortic dissection\u003c/strong\u003e. \u003cem\u003eThe Cochrane database of systematic reviews\u0026nbsp;\u003c/em\u003e2014, \u003cstrong\u003enull\u003c/strong\u003e(2):CD010426.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eExpert consensus document on management of cardiovascular diseases during pregnancy\u003c/strong\u003e. \u003cem\u003eEur Heart J\u0026nbsp;\u003c/em\u003e2003, \u003cstrong\u003e24\u003c/strong\u003e(8):761-781.\u003c/li\u003e\n \u003cli\u003eReutersberg B, Meuli L: \u003cstrong\u003eEarly, Late, or Never? The Unresolved Timing of Thoracic Endovascular Aortic Repair in Type B Aortic Dissection?\u003c/strong\u003e\u003cem\u003eEur J Vasc Endovasc Surg\u0026nbsp;\u003c/em\u003e2025, \u003cstrong\u003enull\u003c/strong\u003e.\u003c/li\u003e\n \u003cli\u003eDe Martino A, Morganti R, Falcetta G, Scioti G, Milano AD, Pucci A, Bortolotti U: \u003cstrong\u003eAcute aortic dissection and pregnancy: Review and meta-analysis of incidence, presentation, and pathologic substrates\u003c/strong\u003e. \u003cem\u003eJ Card Surg\u0026nbsp;\u003c/em\u003e2019, \u003cstrong\u003e34\u003c/strong\u003e(12):1591-1597.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Aortic dissection, Pregnancy complications, Cesarean section, Infant mortality rate, Gestational age","lastPublishedDoi":"10.21203/rs.3.rs-7846542/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7846542/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePregnancy 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.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003ePregnant women and postpartum mothers with concomitant aortic dissection admitted to the Obstetrics Department of the First Affiliated Hospital of Zhengzhou University and the First Affiliated Hospital of Dali University between February 2012 and February 2025 over a 13-year period. The average age was 32.27 years (range: 23\u0026ndash;43 years), and the average gestational age at the occurrence of aortic dissection was 31\u0026thinsp;\u0026plusmn;\u0026thinsp;7 weeks. Thirty-three cases of acute aortic dissection were identified, comprising 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).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAmong the 33 patients, 29 (87.9%) underwent aortic repair surgery, including 14 cases of Type A aortic dissection (TAAD, 82.4%, 14/17) and 15 cases of Type B aortic dissection (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.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eFor pregnant women presenting with thoracolumbar pain and a high suspicion of aortic dissection, timely 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.\u003c/p\u003e","manuscriptTitle":"Clinical Features of Pregnancy-Associated Aortic Dissection and Pregnancy Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-04 13:40:50","doi":"10.21203/rs.3.rs-7846542/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-17T07:06:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-12T13:00:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"175529737927139976773903723229202756729","date":"2025-11-11T05:53:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-06T19:19:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"240028910907420587773091827632854259967","date":"2025-10-27T10:57:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-26T09:50:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"25596350754511683563771041521559888104","date":"2025-10-25T12:42:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-23T11:37:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-15T09:53:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-14T01:26:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-14T01:25:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-10-13T08:35:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5be9484c-eba4-4b4e-a215-4cd9ab1aba1d","owner":[],"postedDate":"November 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-02T16:12:33+00:00","versionOfRecord":{"articleIdentity":"rs-7846542","link":"https://doi.org/10.1186/s12884-026-08716-y","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2026-01-31 15:58:16","publishedOnDateReadable":"January 31st, 2026"},"versionCreatedAt":"2025-11-04 13:40:50","video":"","vorDoi":"10.1186/s12884-026-08716-y","vorDoiUrl":"https://doi.org/10.1186/s12884-026-08716-y","workflowStages":[]},"version":"v1","identity":"rs-7846542","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7846542","identity":"rs-7846542","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}