Aneurysms complicated by pregnancy

I MPROVED care and management of the parturient have resulted in a gratifying reduction in the maternal mortality rate. This has been accomplished primarily by a marked decrease in deaths due to purely obstetrical causes, but those due to nonobstetrical factors have not demonstrated a similar improvement. This emphasizes the necessity of directing attention to the latter group. With increased knowledge and awareness, the obstetrician in cooperation with the internist has been able to decrease the maternal mortality due to cardiac disease, diabetes, and other complications responsive to modern therapeutic regimes. However, there are other nonobstetrical abnormalities which are almost’invariably fatal. This may be attributed largely to an almost universal ladk of suspicion of their presence in conjunction with pregnancy so that the true diagnosis is made too frequently at postmortem examination. Furthermore, there is little clinical consciousness of these entities in pregnancy since scant attention is given to them in obst,etrical teachingl-” and literature. This is unfortunate, since some of these are amenable to correction either before or during pregnancy. Greater awareness will lead to their earlier diagnosis and treatment with resultant improvement in maternal salvage. Aneurysms constitute one of these nonobstetrical abnormalities which have not received adequate attention despite the fact that rupture during pregnancy is associated with a maternal mortality varying from 40 to 100 per cent. Although rupture of an aneurysm most commonly occurs after the age of 40, it may happen during the childbearing period and complicate pregnancy. Furthermore, the various clinical pictures produced by ruptured aneurysms simulate more obvious obstetrical complications. As a result, the treatment instituted is generally not directed toward the actual defect. The purpose of this paper is to stimulate an awareness and develop a clinical consciousness of the coexistence of aneurysms of the arterial system and pregnancy, so that early and adequate therapy may be instituted. Hence, this publication will consider aneurysms of the aorta and its abdominal branches, and a companion paper will discuss cerebral aneurysms. This report is based upon 75 cases of aneurysm of the aorta and 50 cases of aneurysm involving the major branches of the abdominal aorta culled from the literature (Tables I to IV). Two additional cases of saccular aneurysm