Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Forensic Sci Int. 2013 Oct 10;232(1-3):e5-8. doi: 10.1016/j.forsciint.2013.08.005. Epub 2013 Aug 16.
Acute aortic dissection (AAD) in pregnancy is a rare phenomenon. Usually, it occurs during the third trimester, resulting in a catastrophic outcome for both mother and fetus and thus requiring a high level of clinical suspicion and a prompt multidisciplinary approach. There have been numerous such reports published in clinical literatures, yet there is little documentation in forensic literatures. Nearly all the reported cases have been associated with underlying risk factors for aortic pathology, predominantly connective tissue disorders. The author reports a sudden unexpected death due to a ruptured AAD in a 32-year-old pregnant woman with no cardiovascular risk factors at 37 weeks' gestational age. The ascending aortic wall showed a longitudinal intimal tear measured 0.6 cm in length and a longitudinal external tear measured 6 cm in length. Pre-eclampsia superimposed on chronic hypertension was solely possible cause of ruptured AAD in this case. The present case not only illustrates the association of AAD and pregnancy with a resultant fetal-maternal death but also raises awareness of possible such cases.
妊娠期急性主动脉夹层（AAD）较为罕见。通常发生于妊娠晚期，可导致母婴灾难性结局，故需高度临床疑诊并及时多学科处理。此类病例在临床文献中有大量报道，但法医学文献中鲜有记载。几乎所有报道的病例均与主动脉病变的潜在危险因素相关，主要为结缔组织疾病。作者报道了一例 32 岁孕妇在妊娠 37 周时突发意外死亡，死因是升主动脉夹层破裂，该孕妇无心血管危险因素。升主动脉壁有一处长 0.6 厘米的纵向内膜撕裂口和一处长 6 厘米的纵向外膜撕裂口。子痫前期合并慢性高血压可能是导致本例主动脉夹层破裂的唯一原因。本病例不仅阐明了 AAD 与妊娠的相关性及其导致的母婴死亡后果，还提高了对此类病例的认识。
