Clinical Features of Pregnancy-Associated Aortic Dissection and Pregnancy Outcomes

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.