Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China.
Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
BMC Pregnancy Childbirth. 2020 Mar 18;20(1):177. doi: 10.1186/s12884-020-02871-6.
Aortic dissection is a rare and emergent condition. Aortic dissection during pregnancy is not much known but it is quite lethal to both mother and infant. Earlier reports published show that clinicians conducted hysterectomies during cesarean section to avoid anticoagulant-induced uterine bleeding during the following aortic surgery.
A woman (38, gravida 1, para 0) in the 37th gestational week suffered an acute, severe, sharp pain in the chest and back. She was diagnosed with Standford type A aortic dissection and suspected with Marfan syndrome. An emergency cesarean section was performed immediately to deliver the baby. Since the patient was on anticoagulants during aortic replacement, so Cook balloon was inserted into the uterus to prevent postpartum hemorrhage. This helped to maintain the uterus intact. Family genetic testing showed that the patient was a carrier of FBN1 mutation which was inherited from the patient's mother, and the newborn also carried the mutation. Hence the patient was concluded to be positive for Marfan syndrome.
It is important that clinicians should pay attention to the possibility of aortic dissection in a pregnant woman with chest, abdominal or back pain. In this case study, we employed Cook balloon during cesarean section to avoid anticoagulant-induced uterine bleeding during the following aortic surgery.
主动脉夹层是一种罕见且紧急的情况。怀孕期间的主动脉夹层并不多见，但对母亲和婴儿都有很大的致命性。早期发表的报告显示，临床医生在剖宫产时进行子宫切除术，以避免随后的主动脉手术中抗凝剂引起的子宫出血。
一名 38 岁、初产妇 0 的孕妇在第 37 孕周时出现胸痛和背痛的急性、剧烈、锐痛。她被诊断为 Stanford 型 A 主动脉夹层，并怀疑患有马凡综合征。立即进行紧急剖宫产以娩出婴儿。由于患者在主动脉置换期间正在接受抗凝治疗，因此将 Cook 球囊插入子宫以防止产后出血。这有助于保持子宫完整。家族基因检测显示，患者是 FBN1 突变的携带者，该突变遗传自患者的母亲，新生儿也携带该突变。因此，患者被诊断为马凡综合征阳性。
临床医生应该注意胸痛、腹痛或背痛的孕妇发生主动脉夹层的可能性。在本病例研究中，我们在剖宫产时使用 Cook 球囊，以避免随后的主动脉手术中抗凝剂引起的子宫出血。
