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Aortic dissection: turner's patients at risk for cardiac complications.(Obstetrics)
LA JOLLA, CALIF. -- Four pregnancy-related deaths due to aortic dissection and a fifth report describing a woman who survived a dissection 2 weeks after a cesarean section have raised questions about whether Turner's syndrome patients are good candidates for childbearing, even though in vitro fertilization has led many to pursue pregnancy using donor oocytes.
The maternal mortality rate, based on 194 known in vitro fertilization (IVF) pregnancies in Turner's syndrome patients, is estimated to be 2%, Dr. Richard H. Reindollar reported during the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
However, the maternal mortality rate could be even higher than 2%. "This is something we should think long and hard about" as more of these patients pursue pregnancy, said Dr. Reindollar, who is the director of reproductive endocrinology and infertility at Beth Israel Deaconess Medical Center in Boston.
Just because donor oocyte IVF can be used to help these patients become pregnant doesn't mean that it should be used. He stressed that increased cardiac demands of pregnancy may be especially perilous for Turner's syndrome patients, who may be at risk for aortic dilation, dissection, and rupture, even in the absence of risk factors.
He and his associates conducted a survey of 259 donor oocyte programs and found that fewer than half of Turner syndrome patients were screened with echocardiography as part of their work-up (Fertil. Steril. 80[3]:498-501, 2003). Among the 72 screened patients, 6 (8%) had abnormal results.
A subsequent literature review by Dr. Reindollar's team at the medical center and Harvard Medical School in Boston turned up four deaths. They included:
* Two deaths reported in 1997, both of which involved aortic dissection in the third trimester. One patient had a history of hypertension and a slightly dilated aorta.
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