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.