A Case of Acute Aortic Dissection Following Intrapartum in a Patient with Marfan ’ s Syndrome

A 33-year-old woman was admitted at 34⁺⁴ weeks after embryo transfer and over 5 d of cutaneous pruritus. Over 2 years ago, the patient had a third-generation test tube baby due to Marfan's syndrome and gave birth to a live baby girl at full term. This time, the glucose tolerance test during the prenatal examination indicated that the patient was with gestational diabetes, and the blood glucose fluctuated within the normal range after the medical nutrition management and exercise control. The heart ultrasound examination during pregnancy showed that the aortic sinus was enlarged to 40 mm, and the left ventricular systolic function was normal. The patient was diagnosed as "intrahepatic cholestasis of pregnancy (mild)". After admission, the gestational age was verified to be 37⁺² weeks according to the time of embryo transfer, and the diagnostic result was modified to be intrahepatic cholestasis of pregnancy (severe). During the test, the patient complainted back pain, which might interpreted as a sign of aortic dissection. Cesarean section was carried out under multidisciplinary cooperation, during which the amount of bleeding was 600 mL, bilateral uterine artery ligation was performed and a live baby boy was delivered. The body mass of the baby was 3 020 g, and the Apgar scores (1-5-10 min after delivery) were 10-10-10. The postoperative CT angiography showed aortic dissection (Type B). It was found in the follow-up that the patient had no discomforts such as chest tightness and shortness of breath, and recovered well after the delivery.