Pregnancy-related Rupture of Arterial Aneurysms

Jm, Barrett; Je, Van Hooydonk; Fh, Boehm

doi:10.1097/00006254-198209000-00001

Cited by 302 publications

(154 citation statements)

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“…During pregnancy, there is an increase in heart rate, stroke volume, cardiac output, left ventricular wall mass, and enddiastolic dimensions [4]. These hemodynamic states are similar to those in chronic hypertension.…”

Section: Discussionmentioning

confidence: 77%

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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Section: Discussionmentioning

confidence: 77%

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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“…More than 50 % of ruptured arterial aneurysms in females below the age of 40 years are pregnancy-related [9]. Admittedly, in their analysis of the Utrecht population (n=244) Groenestege et al [4] found no increased risk for SAH during pregnancy, delivery and puerperium but in a nationwide epidemiological overview, de Swiet [5] correlated approx.…”

Section: Discussionmentioning

confidence: 98%

“…Some cases were reported that identified specific cerebrovascular disorders as Moyamoya or postpartum cerebral angiopathy [12] triggering peripartum SAH, but these reports are extremely rare. Barrett et al [9] presumed that hemodynamic and endocrine changes of pregnancy may result in arterial wall alterations, potentially leading to aneurysm formation and -rupture. However, many of the maternal SAHpatients were healthy and had no history of preeclampsia-eclampsia [1,2,4-7,10,13].…”

Section: Risk Factorsmentioning

confidence: 99%

“…However, many of the maternal SAHpatients were healthy and had no history of preeclampsia-eclampsia [1,2,4-7,10,13]. Transient vessel degeneration and a decreased ability in compensating hemodynamic changes are conceivably enhanced by hormonal alterations, as suggested by Barrett et al [9]. Although the effective risk remains marginal, spontaneous SAH due to aneurysmal rupture potentially concerns all pregnant women.…”

Section: Risk Factorsmentioning

confidence: 99%

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Subarachnoid Hemorrhage from Posterior Cerebral Artery Aneurysm during Puerperium – Case Report and Review of Literature

Schebesch

Schödel²,

Rennert³

et al. 2012

J Neurol Neurophysiol

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“…8,9 Furthermore, hemodynamic and hormonal changes during pregnancy have been suggested as possible causative factors. 5,12 Other predisposing factors such as trauma, congenital anomalies, infection, arterial degeneration, or inherited vascular disease are extremely uncommon in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Splenic Artery Rupture during Labor: A Case Report

Moghraby

1988

Ann Saudi Med

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FREQUENCY of a splenic artery rupture has been reported as 6.6% out of 45 patients in whom splanchnic artery aneurysms were encountered, 1 with one study reporting 20% of ruptures occurring during pregnancy. 2 Splenic artery rupture is associated with a high maternal mortality of 75% and fetal wastage of 95%, 3 because of the difficulty in diagnosis and delay in surgical intervention. Of more than 90 cases reported in the literature, in only seven did the mother and fetus survive and only 25 mothers survived (including the present case). [4][5][6] To our knowledge, the patient described here is the only case of splenic artery rupture encountered at the Central Maternity Hospital, where deliveries number approximately 18,000 annually. Case ReportA 35-year-old Saudi woman was admitted to the labor suite from a peripheral hospital because of failure to progress after 12 hours of spontaneous labor and suspected rupture of uterus. Her condition had deteriorated suddenly two hours prior to admission at our hospital. The patient had had five full term spontaneous vaginal deliveries at home. Her sixth delivery had been terminated by cesarean section because of placenta previa three years before the current pregnancy. All her offspring were alive and well. Medical and surgical histories were noncontributory. The current pregnancy had progressed normally without antenatal care until the onset of labor at term. The patient was transferred to the hospital from home, when a few hours after the onset of labor, she became irritable and complained of vague abdominal pain. The patient and her husband denied any history of trauma during pregnancy or labor.On admission to Central Maternity Hospital, the patient looked pale and anxious, had a blood pressure of 90/60 mm Hg, and a weak pulse of 110 beats per minute. The uterus was at term and not tender. The fetus was not easily palpable, and fetal heart beat was inaudible. Vaginal examination showed that the cervix was 4 cm dilated, the forewaters were absent, the presentation was cephalic at -3 station, the liquor scanty, and meconium stained. There was no vaginal bleeding. Her hemoglobin was 7 g/dl, the blood group was O (rhesus positive), and her coagulation profile was within acceptable limits. The clinical picture suggested rupture of the lower segment cesarean section scar which led to intra-abdominal hemorrhage and subsequent intrapartum fetal death. Afer initial resuscitation measures, laparotomy was performed through a lower paramedian incision. The peritoneal cavity contained approximately 3,000 ml of free and clotted blood. The uterus was intact. A normal fresh stillborn female infant weighing 3.1 kg and a fundal placenta were delivered by lower segment cesarean section. There was no evidence of retroplacental hemorrhage. Following upward extension of the incision toward the xiphisternum, further exploration showed blood coming from the splenic vessels near the hilum of a normal-looking spleen. The vessels appeared normal with no visible evidence of an aneurysm. Splenecto...

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Pregnancy-related Rupture of Arterial Aneurysms

Cited by 302 publications

References 0 publications

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

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

Subarachnoid Hemorrhage from Posterior Cerebral Artery Aneurysm during Puerperium – Case Report and Review of Literature

Splenic Artery Rupture during Labor: A Case Report

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