404. A nationwide prospective study of aortic dissection in pregnancy using the UK Obstetric Surveillance System (UKOSS)

Abstract

Background Aortic dissection (AD) in pregnancy is a life-threatening event and 50% of cases in women aged 40 years occur during pregnancy.1 Patients with AD present with a wide array of symptoms and the condition may be missed and patients treated for other diseases.2 This study estimated the UK incidence of AD in pregnancy and provided insight into presentation and management practices. Methods A national prospective population-based study was undertaken across 229 hospitals over a 2-year period. Participants were diagnosed (a) using suitable imaging (echocardiography, CT or MRI) or (b) at surgery/postmortem. Results The estimated UK incidence of AD in pregnancy was 1.31 per 100,000 maternities (95% CI 0.69–1.93 per 100,000) with 17 cases confirmed by diagnostic criteria. The mean [SD] age of women was 32.5[7.2]years. Fourteen cases were due to type-A dissection (involving ascending aorta), the remainder type-B (no involvement of ascending aorta). Nine women died, all of whom with type-A dissection, giving a case fatality rate of 53%. We compared the UKOSS data for survivors to information available for 21 women with confirmed AD who died (during and just after the UKOSS study period). There were no differences in age, BMI or ethnicity but increased prevalence of pre-existing co-morbidities in women who died. On initial presentation all survivors complained of anterior chest pain (compared to 66% who died). Survivors were more likely to have recorded bilateral BP and pulse readings, prompt imaging (87.5% underwent echocardiography  + either CT/MRI aorta). In the survivor group (n = 8), 5 women successfully underwent surgical aortic root replacement (for type-A dissection) after appropriate BP control usually β -blockade. 3 were conservatively managed for type-B dissection. Discussion AD is a rare but serious illness. Thorough physical examination and prompt imaging with quick access to surgery (type-A) or conservative management (typeB) could prevent mortality from AD.