Aortic Dissection/Dissecting Aortic Aneurysm

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Key points

  • Aortic dissection in pregnancy is a significant cause of maternal morbidity and mortality
  • Changes in birth patterns, with a rise in older mothers and increased prevalence of obesity may contribute to an increased occurrence of aortic dissection in the UK
  • There have been no prospective studies to estimate the incidence of this disease and its investigation and management during pregnancy
  • This study will determine the national incidence of aortic dissection in the pregnant population in the UK and use this national initiative to characterize and quantify risk factors for aortic dissection in pregnancy

Surveillance Period

Sept 2009 – Sept 2011

Background

Aortic dissection in pregnancy is a life-threatening event to both mother and baby and accounts for 14% of maternal cardiac deaths[1]. Although rare, an association between pregnancy and aortic dissection has been reported and its incidence in pregnancy is rising. Approximately 50% of cases of aortic dissection in women under the age of 40 occur whilst they are pregnant[2]. Patients presenting with aortic dissection may do so with a wide array of symptoms and the condition may be missed or symptoms mistaken for other diseases in pregnancy[3][4]. There is often an over-cautious approach by clinicians to imaging studies required for the diagnosis of aortic dissection for fear of radiation effects on the baby and this may hinder prompt diagnosis[3][4]. Untimely delays in treatment of this disease can lead to potentially catastrophic consequences, since the mortality rate increases by 1% each hour if left untreated[5].

Current understanding of aortic dissection and its management in pregnancy is limited. Published data is mainly in the form of case reports with no clear management guidelines for this disease. Risk factors for aortic dissection within the pregnant population are equally not well-defined. Changes in birth patterns with a rise in older mothers and increased prevalence of obesity may increase the occurrence of aortic dissection, therefore an up to date understanding of the risk factors for aortic dissection in pregnancy is urgently required. This study will determine the national incidence of aortic dissection in pregnancy and will provide information on the current investigation, management and maternal-foetal outcomes of this disease in the UK.

Objectives

  1. To use the UK Obstetric Surveillance System to estimate national incidence of new onset aortic dissection in pregnancy and to study the prevalence and outcomes of women with pre-existing aortic dissection or previous aortic repair who become pregnant.
  2. To characterise major risk factors and analyse the clinical investigation and management undertaken in pregnant patients with pre-existing or new onset aortic dissection.
  3. To use the results to improve early recognition and management of aortic dissection in pregnancy and assist in devising future clinical guidelines.

Research questions

  • What is the current incidence of aortic dissection in the UK?
  • What are the risk factors for aortic dissection in pregnancy?
  • How is aortic dissection diagnosed in pregnancy in the UK?
  • How are the various aortic dissection subtypes in pregnancy managed in the UK?
  • What are the maternal-foetal outcomes in patients diagnosed with aortic dissection?
  • What is the prevalence and clinical outcome of patients with previous aortic dissection or previous aortic repair who become pregnant?

Case definition

Cases are defined as any women in whom the diagnosis of:

(1) aortic dissection (also referred to as dissecting aortic aneurysm) was confirmed using suitable imaging (Echocardiography, Computed tomography, Magnetic Resonance Imaging) or (2) aortic dissection confirmed at surgery or postmortem. Cases should be recorded for women with new onset aortic dissection and those with pre-existing aortic dissection or previous aortic repair prior to pregnancy.

Funding

Heart Research UK has funded this UKOSS study (Grant Ref RG2575/09/10).

Ethics approval

The study has been approved by the London MREC (study ref 09/H0721/47)

Investigators

Sheba Jarvis, Mandish Dhanjal, Richard Gibbs, Catherine Williamson

Imperial College Healthcare NHS Trust, Queen Charlottes and Chelsea Hospital

Download the Data Collection Form (DCF)

UKOSS Aortic Dissection/Dissecting Aortic Aneurysm Form

References

  1. ^ Confidential Enquiry into Maternal and Child Health (CEMACH) UK http://www.cemach.org.uk.
  2. ^ Katz NM, Collea JV, Moront MG, MacKenzie RD, Wallace RB (1984) Aortic dissection.
  3. a, b Lewis S, Ryder I, Lovell AT (2005). Peripartum presentation of an acute aortic dissection.Br J Anaesth.;94(4):496-9.
  4. a, b Wahlers T, Laas J, Alken A, Borst HG (1994). Repair of acute type A aortic dissection after cesarean section in the thirty-ninth week of pregnancy. J Thorac Cardiovasc Surg. 107(1):314-5.
  5. ^ Mészáros I, Mórocz J, Szlávi J, Schmidt J, Tornóci L, Nagy L, Szép L (2000). Epidemiology and clinicopathology of aortic dissection. Chest.;117(5):1221-3.

Updated: Tuesday, 07 July 2020 14:37 (v4)