Mx of worsening Aortic Dilation and Insufficiency in a 20-We
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Strict prenatal care is necessary in pregnant women with underlying cardiac disease. Lewis and Drife reported cardiac disease to be the second most common cause of maternal death in the UK from 2000 to 2002. Recent evidence suggests an inherent risk of aortic dissection from pregnancy even without prior cardiac history. Women with known worsening aortic dilation or aortic insufficiency have been shown to be at increased risk for heart failure, rupture, or aortic dissection during pregnancy.

Physiologic hemodynamic changes during pregnancy can complicate cardiovascular disease. Normally, as gestational age increases, cardiac output and intravascular volume continue to rise. In patients with preexisting aortic disease, these changes increase the risk for aneurysm formation or dissection. During labor, cardiac output elevates even further, potentiating the possibility of aortic disruption. As a result, some of these patients undergo either termination of pregnancy or early cesarean delivery (depending on the patient's circumstances or preferences) to prevent further risk.

A 32-year-old multipara presented to a large academic institution with a 20-week intrauterine pregnancy. She was diagnosed with polyarteritis nodosa as a child and was treated with both steroidal and nonsteroidal anti-inflammatory agents. After her teenage years, she had no relapses of her disease. However, in her previous pregnancy 3 years prior to this index presentation, the patient developed chest pain in the late mid-trimester. Evaluation at that time revealed aortic valve insufficiency and aortic dilation. She was intentionally delivered by preterm cesarean delivery at 30 weeks to avoid worsening hemodynamics should the pregnancy continue. The patient was placed on postpartum oral contraceptives but was again found to be pregnant.....