Treatment of Thoracic Aortic Dissection in Pregnancy

Clinical Scenario

Acute aortic dissection during pregnancy is a time-critical emergency. Pregnancy produces hemodynamic and hormonal changes that elevate the risk of aortic dissection in women with aortopathy. When dissection occurs, urgent coordinated input from obstetric and cardiac surgical teams is essential, as the appropriate course of action depends on the viability of the fetus and the condition of the mother.

Treatment Approach

Management is determined by the anatomic type of dissection and the stage of pregnancy. Both surgical and obstetric interventions play a role, but the specific strategy — and its sequencing — varies substantially across clinical presentations.

The complete type-specific and trimester-specific decision pathway is available in the full protocol below.

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References

DOI: 10.1161/CIR.0000000000001106

Pregnancy leads to hemodynamic and hormonal changes and is a risk factor for aortic dissection in women with aortopathy.
If type A aortic dissection occurs during pregnancy, urgent obstetric and cardiac surgical consultation is necessary, because management strategies depend on the viability of the fetus and condition of the mother.
In patients experiencing an acute type A aortic dissection during the first or second trimester of pregnancy, urgent aortic surgery with fetal monitoring is recommended.
In patients experiencing an acute type A aortic dissection during the third trimester of pregnancy, urgent cesarean delivery immediately followed by aortic surgery is recommended.
In patients experiencing an acute type B aortic dissection during pregnancy, medical therapy is recommended, unless endovascular or surgical therapy is required to manage acute complications.

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