Treatment
Patients were admitted to the hospital through emergency or referral.
After admission, multiple departments, including obstetrics,
anesthesiology, cardiovascular surgery, pediatrics and intensive care
unit (ICU), jointed to formulate combined treatment schemes. The safety
of both mother and fetus was considered, which mother’s safety was given
priority. According to the patient’s condition, low flow oxygen
inhalation and drugs for pain relief and sedation were given.
Medications were used to maintain systolic blood pressure between 100
and 120 mmHg7, to limit the extension of the
dissection and reduce the risk of developing end-organ damage and
rupture8. The status of the fetus was monitored by
ultrasound and fetal heart electronic monitoring.
All five patients were planned to perform TEVAR and terminate pregnancy
through cesarean section. The timing and method of surgery were
determined by the patient’s condition, gestational age and
comorbidities. Cesarean section might be conducted before, immediately
after, or for a period after TEVAR. For patients planning to experience
TEVAR first, the times of arterial imaging should be minimized as much
as possible, and the surgery should be finished within a short time to
reduce the impact of radiation exposure and general anesthesia on the
fetus. For patients undergoing cesarean section, abdominal pressure and
uterotonics should be avoided to minimize the impact on the
cardiovascular system and fluctuations of the hemodynamic. Uterine
artery ligation should be used to prevent postpartum hemorrhage. Infants
were resuscitated by neonatologists according to the Neonatal
Resuscitation Program guidelines. For patients who have not terminated
pregnancy yet, the status of the fetus should be monitored intensively.