Aortic dissection in pregnancy and the postpartum period

Pregnancy-associated aortic dissection (AD) is a rare event, with an incidence of 0.0004% per pregnancy. The work of the Aortic Dissection Collaborative identified pregnancy-associated AD as a high-priority topic, despite its rarity. The Pregnancy Working Group, which included physicians and patient...

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Published in:Seminars in vascular surgery 2022-03, Vol.35 (1), p.60-68
Main Authors: Russo, Melissa, Boehler-Tatman, Mattie, Albright, Catherine, David, Carmen, Kennedy, L'Oreal, Roberts, Aaron W., Shalhub, Sherene, Afifi, Rana, Case, Melanie, Cotter, Novelett E., David, Carmen C., Fasano, Mark, Goldenberg, Richard, Howitt, Jake, Söderlund, Timo T., Trotter, Debra, Rabin, Asaf, Russo, Melissa L., Drudi, Laura Marie, Marks, Laura L., Yousif, Maisoon D., Hoffstaetter, Tabea, Taubenfeld, Ella, Vemulapalli, Sreekanth, Campos, Chrisanne S., Rusche, Lindsey, Pena, Robert C.F., Mussa, Firas F., MacCarrick, Gretchen, Goldsborough, Earl, Samuel, Christeen, Xu, Lillian, Mouawad, Nicolas J., Yassa, Eanas S., Teng, Xiaoyi, Politano, Amani, Teindl, Jesse, Bloom, Lara, Gluck, Rebecca, O'Neal, Meredith Ford, Grima, Josephine, Masciale, Eileen, Ota, Takeyoshi, Wright, Katelyn, Hakim, Alan J., Owens, Gareth, Arnaoutakis, George J., Judelson, Dejah, D'Oria, Mario, Rio-Sola, Lurdes del, Ajalat, Mark, Chau, Marvin, Talutis, Stephanie D., Woo, Karen, Wohlauer, Max V., Yi, JeniannA, Eagle, Kim A., Bowman, Marion A. Hofmann, MS, Eva Kline-Rogers, Kim, Hyein, Henoud, Claudine, Damrauer, Scott, Krol, Emilia, Afifi, Rana O., Cecchi, Alana C., Drake, Madeline, Estrera, Anthony, Hebert, Avery M, Milewicz, Dianna M., Prakash, Siddharth K., Sandhu, Harleen, Smith-Washington, Akili, Tanaka, Akiko, Watson, Jacob, Ahmad, Myra, Albright, Catherine M., Burke, Christopher R., Byers, Peter H., Lawrence, Sarah O., Lee, Jenney R., Medina, Jonathan, Nishath, Thamanna, Pham, Julie, Segal, Courtney, Soto, Michael, Catalan, Linell, Patterson, Megan, Ilonzo, Nicole
Format: Article
Language:English
Subjects:
Aortic Dissection - epidemiology
Aortic Dissection - therapy
Female
Humans
Multicenter Studies as Topic
Postpartum Period - psychology
Pregnancy
Risk Factors
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Summary:Pregnancy-associated aortic dissection (AD) is a rare event, with an incidence of 0.0004% per pregnancy. The work of the Aortic Dissection Collaborative identified pregnancy-associated AD as a high-priority topic, despite its rarity. The Pregnancy Working Group, which included physicians and patient stakeholders, performed a systematic literature review of pregnancy-associated AD from 1960 to 2021 and identified 6,333 articles through PubMed, OVID MEDLINE, Cochrane, Embase, CINAHL and Web of Science. The inclusion criterion was AD in pregnant populations and exclusion criteria were case reports, conference abstracts, and languages other than English. Assessment of full-text articles for eligibility after removal of duplicates from all databases yielded 68 articles to be included in the final review. Topics included were timing of AD in pregnancy, type of AD, and management considerations of pregnancy-associated AD. The Pregnancy Working Group identified gaps in knowledge and future areas of research for pregnancy-associated AD, including clinical management, mental health outcomes post AD, reproductive and genetic counseling, and contraception after AD. Future collaborative projects could be a multicenter, international registry for all pregnancy-associated AD to refine the risk factors, best practice and management of AD in pregnancy. In addition, future mixed methodology studies may be useful to explore social, mental, and emotional factors related to pregnancy-associated AD and to determine support groups’ effect on anxiety and depression related to these events in the pregnancy and postpartum period.
ISSN:0895-7967
1558-4518
DOI:10.1053/j.semvascsurg.2022.02.010