Fetomaternal blood flow measurements and management of combined coarctation and aneurysm of the thoracic aorta in pregnancy

Michael J. Kupferminc, Joseph B. Lessing, Ariel Jaffa, Bernardo A. Vidne, M. Reuben Peyser

Research output: Contribution to journalArticlepeer-review

Abstract

A pregnant patient presented at 21 weeks of gestation with severe coarctation of the aorta and a large aneurysm (5.4 cm) of the ascending aorta. The patient developed hypertension at gestation week 17. Continuous Doppler wave velocimetry showed a low systolic/diastolic (S/D) ratio in the uterine arteries indicating reduced blood flow to the placenta. The presence of a severe coarctation, aneurysm of the ascending aorta, and hypertension associated with the hemodynamic changes of pregnancy, increases maternal and fetal risk. The literature reviewed disclosed that aneurysm expansion and dissection or rupture on the one hand, and fetal demise on the other, are the greatest risks. The challenge of treating both the patient and the fetus was managed successfully by correction of the coarctation at week 22. Blood pressure normalized a few weeks after the operation, and no expansion in aneurysm diameter was noticed. A normal S/D ratio in the uterine arteries indicated increased blood flow in the uterine arteries. A healthy female was born. Pregnant patients with coarctation of the aorta should have surgical correction preferably in the first or second trimesters. 1993 Acta Obstet Gynecol Scand

Original languageEnglish
Pages (from-to)398-402
Number of pages5
JournalActa Obstetricia et Gynecologica Scandinavica
Volume72
Issue number5
DOIs
StatePublished - Jul 1993

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