Dissection in pregnancy

Dissection is uncommon in pregnancy except in those with Marfan's syndrome, particularly those with aortic root dilation and progressive aortic regurgitation who may develop dissection at any stage of pregnancy. Those with no aortic regurgitation and an aortic root diameter below 4.5 cm have a better prognosis. Termination should be considered in the first trimester if there is evidence of progressive aortic root dilatation. Beta-blockade may reduce the risk of dissection and aortic root dilation but experience is limited.

Patients without Marfan's syndrome are most prone to dissection in the third trimester and the peripartum period. Diagnosis is best made by transesophageal echocardiography; treatment is by emergency blood pressure control with careful fetal monitoring and early surgery. An emergency Cesarean section will usually be necessary; however, the maternal and fetal mortalities remain very high.

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