Backache After Extradural Anaesthesia in the Postpartum Period: Dissection of Thoracic Aneurysm

Abstract

We describe a case of postpartum ruptured dissecting aneurysm of the thoracic aorta, unrelated to the anaesthetic management with extradural anaesthesia. This complication is discussed in detail, as the anaesthetist may be the specialist required to respond to the common presenting symptom of severe back pain.

Pregnancy complicated by aortic dissection: caesarean delivery during extradural anaesthesia

“…A high index of suspicion with regard to pain in the abdomen or back is necessary, especially in a pregnant patient. This was exemplified by our case and in another in which unrelenting back pain following an extradural for labour was the first indication of aortic dissection [10]. Our patient survived the initial dissection and, although not diagnosed initially on clinical grounds, further management emphasizes the importance of specialized investigative procedures.…”

Aortic Dissection During Pregnancy: A Difficult Clinical Scenario

“…The literature retrieval yielded 96 reports, comprising 85 case reports and 11 case series or original articles, with 122 patients . Mean patient age (n = 120) was 31.6 ± 4.7 years (range, 19–43 years; median, 31.5 years) on admission.…”

“…Estrogen suppresses the synthesis of collagen and elastin . Such hormonal effects may weaken the vascular walls, thereby playing an important role in the development of AoD . Marfan, Turner, and Ehlers‐Danlos syndromes are inherited connective‐tissue disorders often characterized by disruption of the integrity of structural proteins, particularly of the aorta, affecting aortic composition and function so that patients are predisposed to aortic aneurysmal formation and dissection at early ages…”

“…106 Such hormonal effects may weaken the vascular walls, thereby playing an important role in the development of AoD. 22 Marfan, Turner, and Ehlers-Danlos syndromes are inherited connective-tissue disorders often characterized by disruption of the integrity of structural proteins, particularly of the aorta, affecting aortic composition and function so that patients are predisposed to aortic aneurysmal formation and dissection at early ages. 107 A prospective study illustrated that women with Marfan syndrome with aortic dilation <40 mm tolerated pregnancy well, with good maternal and neonatal outcomes, whereas those with aortic-root diameters ≥40 mm at pregnancy seem to be at higher risk for aortic dilation, rupture, or dissection.…”