Adult

Aortic Dilatation and Pregnancy

Background

The aorta is the main large blood vessel which leaves the heart and supplies blood to the whole body. In certain conditions the aorta may be stretched or more fragile than usual and this can be important during or after pregnancy.

The effect of pregnancy

During pregnancy there is more stress and strain on the wall of the aorta, and the hormones associated with pregnancy make the aorta even stretchier than usual – this makes it easier for a tear (or dissection) of the aorta to develop.

Aortic conditions

The following conditions carry an increased chance of aortic stretch and tearing during pregnancy; Marfans syndrome, Loeys Dietz syndrome, Turners syndrome, vascular Ehlers Danlos syndrome (Type 4), bicuspid aortic valve with aortic dilatation, repaired congenital heart disease with aortic dilatation. However, there are rare instances when aortic tears can occur in pregnancy without an underlying diagnosis.

Aortic dissection or tear

This is a rare, but very serious complication. It usually presents very suddenly with severe central chest pain, often also felt in the back between the shoulder blades. This pain is often described as a ’tearing’ pain. This is often associated with feeling dizzy and sick, and sweating profusely. In these circumstances a 999 ambulance should be called, and you should be brought directly to a major A&E unit with cardiac surgery on site. In Yorkshire and Humber, this would be Leeds General Infirmary, Castle Hill Hospital in Hull or the Northern General Hospital in Sheffield.
Occasionally, aortic tears can present with more minor symptoms. If you are known to have a dilated aorta and experience any unusual pain (usually felt in the centre of the chest or the back), this will need to be checked out by a doctor or midwife, as soon as possible. Please ensure they are aware of your diagnosis.

Monitoring

Because you are known to have a dilated aorta, we will be seeing you frequently in the clinic, and monitoring the size of your aorta carefully with heart scans. If we see an increase in the size of the aorta, we may recommend that your baby is delivered early. Occasionally we will recommend a caesarean section rather than a normal delivery.

Cardiology Obstetric team, Leeds Teaching Hospitals Trust
Written June 2018; for review June 2020