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8.2. Delivery in Pregnant Patients With Aortopathy
COR LOE
Recommendations
1 C-EO 1. In pregnant patients with a history of chronic aortic
dissection, cesarean delivery is recommended.
1 C-EO 2. In pregnant patients with an aortopathy and an aortic
diameter of <4.0 cm, vaginal delivery (when otherwise
appropriate) is recommended.
2a C-EO 3. In pregnant patients with a diameter of the aortic root,
ascending aorta, or both, of ≥4.5 cm, cesarean delivery is
reasonable.
2b C-EO 4. In pregnant patients with a diameter of the aortic root,
ascending aorta, or both, of 4.0 cm to 4.5 cm, vaginal delivery
with regional anesthesia, expedited second stage, and assisted
delivery may be reasonable.
2b C-EO 5. In pregnant patients with syndromic and nsHTAD, and a
diameter of the aortic root, ascending aorta, or both, of 4.0 cm
to 4.5 cm, cesarean delivery may be considered.
8.3. Surgery Before Pregnancy in Women With Aortic Disease
COR LOE
Recommendations
1 C-LD 1. In patients with Marfan syndrome and an aortic root diameter
of >4.5 cm, aortic surgery before pregnancy is recommended.
2b C-LD If the aortic root diameter is 4.0 cm to 4.5 cm, aortic surgery
before pregnancy may be considered, especially if there are
risk factors for aortic dissection (ie, rapid aortic growth of
≥0.3 cm/y or a family history of aortic dissection).
2a C-EO 2. In patients with Loeys-Dietz syndrome attributable to
pathogenic variants in TGFB2 or TGFB3 and an aortic
diameter of ≥4.5 cm, surgery before pregnancy is reasonable.
2b C-EO If the Loeys-Dietz syndrome is attributable to pathogenic
variants in TGFBR1, TGFBR2, or SMAD3, and the aortic
diameter is ≥4.0 cm, surgery before pregnancy may be
considered.
1 C-EO 3. In patients with nsHTAD and an aortic diameter of ≥4.5 cm,
surgery before pregnancy is recommended.
2b C-EO If the aortic diameter is 4.0 cm to 4.4 cm, surgery before
pregnancy may be considered, depending on the molecular
diagnosis, family history, and aortic growth rate.
1 C-LD 4. In patients with Turner syndrome and ASI of ≥2.5 cm/m
2
,
surgery before pregnancy is recommended.
