Management and Outcomes of Aortic Dissection Type B in Late Pregnancy: A Retrospective Case Series

( BJOG. 2024;131:1874-1881. doi: 10.1111/1471-0528.17923) The occurrence of aortic dissection (AD) during pregnancy is rare (4 out of 1 million pregnancies); however, when it occurs, it often contributes to maternal and neonatal morbidity and mortality. The Stanford classification lists 2 different types of AD (A and B)—type A involving the ascending aorta and type B involving the descending aorta. Rupture of either type can lead to sudden death, yet a recent study describes higher hospital mortality rates for those in the type B group. Evidence also suggests an increase in the incidence of type B AD, which causes increased concerns amongst medical professionals. Depending on whether the AD ruptures or malperfusion syndrome coexists determines the classification as complicated when either is present or uncomplicated when neither exist. In the general population, thoracic endovascular aortic repair (TEVAR) is the recommended treatment for a complicated AD, although evidence in pregnancy is lacking. Specifically, there is question of whether delivery should occur before TEVAR in late gestation to minimize neonatal harm, or whether the maternal morbidity and mortality risk outweighs any potential for neonatal harm.