Dr Muhammad Hamid Raza, Dr Danial Ahmed, Dr Awais Ghulam Nabi
Introduction: Aortic dissection (AoD) during pregnancy is rare and life threatening for both mother and fetus. Aortic dissection typically occurs in the third trimester of pregnancy or during the early postpartum period. Aims and objectives: The main objective of the study is to analyze the anaesthetic challenges in repair of acute aortic dissection rupturing into the pericardium in a pregnant women. Material and methods: This descriptive analysis was conducted in Allied Hospital Faisalabad during June 2019 to November 2019. This was basically a case study, we report 6 cases in hospital during this period. The mean age of these pregnant women at admission was 30.2 years (range, 24 to 36 years). Apart from 1 primigravida, all women were multigravidae. Symptoms at admission ranged from dyspnea and pain in the left hemithorax, to severe decompensation with hypotension, anuria, and coma. Results: Five patients underwent surgical intervention. Four with a type A dissection were all operated on emergently. A cesarean section was performed in 2 at the same operative session, before the aortic repair in both. Cesarean section was done 5 days after aortic repair in the third patient and 16 weeks later in the fourth patient. There was no maternal morbidity, but 3 patients suffered major complications. The immediate postoperative course in one of the patients with the type A dissection was complicated by severe, recurrent intestinal bleeding and perforation, necessitating gastric resection. Conclusion: It is concluded that cesarean section with concomitant aortic repair is recommended for pregnant women with a type A dissection, depending on the gestational age.