Challenges for Emergent Combined Cesarean Delivery and Type A Aortic Dissection Repair Including Bleeding Management in the Setting of Full Heparinization: A Case Report

Cory Y. Lin; Chelsea L. Stiles; Sudhakar Subramani; Matthew J. Maxwell; Dionne F. Peacher; Sharon B. Larson; Satoshi Hanada

doi:10.7759/cureus.30647

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Challenges for Emergent Combined Cesarean Delivery and Type A Aortic Dissection Repair Including Bleeding Management in the Setting of Full Heparinization: A Case Report

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Challenges for Emergent Combined Cesarean Delivery and Type A Aortic Dissection Repair Including Bleeding Management in the Setting of Full Heparinization: A Case Report

Cory Y. Lin, Chelsea L. Stiles, Sudhakar Subramani, Matthew J. Maxwell, Dionne F. Peacher, Sharon B. Larson and Satoshi Hanada

Curēus (Palo Alto, CA), Vol.14(10), e30647

10/24/2022

DOI: 10.7759/cureus.30647

PMCID: PMC9684002

PMID: 36439601

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Abstract

Type A aortic dissection is rare in young females; however, it is associated with a high mortality rate. This case report describes a 30-year-old female at 38 weeks of gestation who presented with acute onset chest pain and hypotension responsive to intravenous fluid therapy. Transthoracic echocardiogram and chest computed tomography angiography confirmed a type A aortic dissection. The patient was transported urgently to the operating room for a Cesarean section and aortic dissection repair. Following induction of general anesthesia, the baby was delivered, oxytocin infusion was started, and a Bakri balloon was placed in the uterus. On cardiopulmonary bypass with circulatory arrest, the ascending aorta and aortic valve were repaired. Multiple uterotonic agents were required intraoperatively to manage persistent uterine bleeding in the setting of full heparinization. Both mother and baby survived without major complications. Preoperative management should focus on maternal hemodynamic control while completing a diagnostic evaluation. Intraoperative considerations include minimizing fetal exposure to medication, maintaining hemodynamic stability, and managing intraoperative blood loss in the setting of full anticoagulation.

General & Internal Medicine

Life Sciences & Biomedicine

Medicine, General & Internal

Science & Technology

Details

Title: Subtitle: Challenges for Emergent Combined Cesarean Delivery and Type A Aortic Dissection Repair Including Bleeding Management in the Setting of Full Heparinization: A Case Report
Creators: Cory Y. Lin - University of Iowa
Chelsea L. Stiles - Iowa Methodist Medical Center
Sudhakar Subramani - University of Iowa
Matthew J. Maxwell - Houston Methodist
Dionne F. Peacher - University of Iowa
Sharon B. Larson - University of Iowa
Satoshi Hanada - University of Iowa
Resource Type: Journal article
Publication Details: Curēus (Palo Alto, CA), Vol.14(10), e30647
DOI: 10.7759/cureus.30647
PMID: 36439601
PMCID: PMC9684002
NLM abbreviation: Cureus
eISSN: 2168-8184
Publisher: Cureus Inc
Number of pages: 5
Language: English
Date published: 10/24/2022
Academic Unit: Anesthesia; Cardiothoracic Surgery
Record Identifier: 9984320003802771

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