Effects of the Pregnant Uterus on the Abdominal Aorta and its Branches

Ohlson, Lars

doi:10.1177/028418517801900212

Cited by 33 publications

(13 citation statements)

References 6 publications

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“…This may be exacerbated by increased outflow resistance in the distal aorta due to compression by the gravid uterus. 30 Pregnancy also causes hormonal and biochemical changes that may modify the ability of the aorta to withstand the hemodynamic effects placed on it. The importance of dysregulated signaling (e.g., by TGF-beta) in the genesis of a number of conditions associated with aortic aneurysms 8 suggests one pathway by which the hormonal and biochemical effects of pregnancy may mediate the risk of aortic complications.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy and the Risk of Aortic Dissection or Rupture

et al. 2016

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Background Case series have described aortic dissection and rupture in pregnancy. Few population-based data exist to support an association. Methods We performed a cohort-crossover study using data on all emergency department visits and acute care hospitalizations at nonfederal healthcare facilities in California, Florida, and New York. We included women ≥12 years of age with labor and delivery or abortive pregnancy outcome between 2005 and 2013. Our outcome was a composite of aortic dissection or rupture. Based on the timing of reported aortic complications during pregnancy, we defined the period of risk as 6 months before delivery until 3 months after delivery. We compared each patient's likelihood of aortic complications during this period to an equivalent 270-day period exactly 1 year later. Incidence rates and incidence rate ratios were computed using conditional Poisson regression with robust standard errors. Results Among 6,566,826 pregnancies in 4,933,697 women, we identified 36 cases of aortic dissection or rupture during the pregnancy or postpartum period and 9 cases during the control period 1 year later. The rate of aortic complications was 5.5 (95% confidence interval [CI], 4.0-7.8) per million patients during pregnancy and the postpartum period, compared with 1.4 (95% CI, 0.7-2.9) per million during the equivalent period 1 year later. Pregnancy was associated with a significantly increased risk of aortic dissection or rupture (incidence rate ratio, 4.0; 95% CI, 2.0-8.2) compared to the control period 1 year later. Conclusions The risk of aortic dissection or rupture is elevated during pregnancy and the postpartum period.

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Section: Discussionmentioning

confidence: 99%

Pregnancy and the Risk of Aortic Dissection or Rupture

et al. 2016

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“…Besides the preexisting congenital valvular, connective tissue or genetic disorders, aortic compression due to gravid uterus was hypothesized to increase outflow resistance on the aorta [10]. Pregnancy induced hormonal changes, like increased estrogen concentrations during pregnancy, may also disrupt the normal corrugation of elastic fibers [11].…”

Section: Discussionmentioning

confidence: 99%

“…Atherosclerosis, hypertension, genetic disorders of connective tissue, genetic conditions such as turner's syndrome, valvular abnormalities and vascular diseases like preeclampsia are risk factors of aortic dissection [9]. In pregnancy aortic compression due to the gravid uterus was also hypothesized to increase outflow resistance on the aorta [10]. Pregnancy induced hormonal changes, like increased estrogen concentrations during pregnancy, also may disrupt the normal corrugation of elastic fibers [11].…”

Section: Introductionmentioning

confidence: 99%

Maternal Death Due to Acute Aortic Dissection-Autopsy Diagnosis: A Case Report

Kasap¹

2015

CSMC

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“…These hemodynamic states are similar to those in chronic hypertension. The gravid uterus has been reported to cause signifi cant compression of the aorta and iliac arteries, especially in the supine position, and this may increase the outfl ow resistance of the lower arterial trees [5]. The concurrent increase in cardiac ejection into the upper aorta may further predispose the patient to the initiation of an intimal tear, causing aortic dissection [6].…”

Section: Discussionmentioning

confidence: 99%

Unexpected acute aortic dissection after elective cesarean section delivery: Report of a case and review of the literature

Kang

Lee

Rhee

et al. 2011

Korean J Obstet Gynecol

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Acute aortic dissection may indeed be a rare complication of pregnancy, and the majority of aortic dissections usually occur during the third trimester of pregnancy. Most aortic dissections occur as a result of systemic hypertension or connective tissue disorders. Without any treatment, more than 50% of patients die within the initial 48 hours, and the 3-month mortality rate is as high as 90%. Because the pain in puerperal women is uncertain and diffi cult to discriminate from physiologic pain, the diagnosis of aortic dissection is complex and requires a high index of suspicion. We experienced a case of unexpected acute aortic dissection that occurred after elective cesarean section delivery in a young woman without any known risk factors. This case of aortic dissection was managed medically. In postpartum patients complaining of chest pain, the suspicion of aortic dissection is important for prompt diagnosis and better prognosis.

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Effects of the Pregnant Uterus on the Abdominal Aorta and its Branches

Cited by 33 publications

References 6 publications

Pregnancy and the Risk of Aortic Dissection or Rupture

Pregnancy and the Risk of Aortic Dissection or Rupture

Maternal Death Due to Acute Aortic Dissection-Autopsy Diagnosis: A Case Report

Unexpected acute aortic dissection after elective cesarean section delivery: Report of a case and review of the literature

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