Spontaneous rupture of acute ascending aortic dissection in a young pregnant woman: A sudden unexpected death

Abstract

Acute aortic dissection (AAD) in pregnancy is a rare phenomenon. Usually, it occurs during the third trimester, resulting in a catastrophic outcome for both mother and fetus and thus requiring a high level of clinical suspicion and a prompt multidisciplinary approach. There have been numerous such reports published in clinical literatures, yet there is little documentation in forensic literatures. Nearly all the reported cases have been associated with underlying risk factors for aortic pathology, predominantly connective tissue disorders. The author reports a sudden unexpected death due to a ruptured AAD in a 32-year-old pregnant woman with no cardiovascular risk factors at 37 weeks' gestational age. The ascending aortic wall showed a longitudinal intimal tear measured 0.6 cm in length and a longitudinal external tear measured 6 cm in length. Pre-eclampsia superimposed on chronic hypertension was solely possible cause of ruptured AAD in this case. The present case not only illustrates the association of AAD and pregnancy with a resultant fetal-maternal death but also raises awareness of possible such cases. © 2013 Elsevier Ireland Ltd.