Objective: Pregnancy with complicated type B aortic dissection is a rare but devastating scenario. And there are no definitive guidelines for management and therapy. We report our exploration and experiences of managing five pregnant with complicated TBAD in the second or third trimesters, aiming to propose an appropriate management strategy. Design: Retrospective study. Setting: Zhongnan Hospital of Wuhan University. Population: Pregnant women with TBAD Methods: The clinical data of 5 pregnant women with TBAD who were admitted to the Zhongnan Hospital of Wuhan University from January 2022 to June 2023 were collected. The clinical features, diagnostic procedures, treatment strategies and corresponding maternal and infant outcomes were retrospectively analyzed. Main Outcome Measures: The survival of mother and fetus. Result: All five pregnant women with TBAD were diagnosed with complicated TBAD. The average age of the patients was (34.8±8.13) years, and the range of gestational weeks at admission was 27 weeks plus 3 days to 36 weeks plus 6 days. The first patient intending to receive a cesarean section and subsequent TEVAR died of rupture of aortic dissection during cesarean section. Her neonate was successfully rescued. The remaining four patients who underwent TEVAR first survived. Three underwent single-stage aortic repair and delivery, and one patient underwent cesarean section 27 days after TEVAR. Three preterm live births of these four patients were recorded. During late follow-up, no maternal and fetal deaths occurred. Neither device-related nor systemic complications post TEVAR were observed in the mother. Routine physical examinations of four live births showed no abnormalities. Conclusion: When a pregnant woman in the second or third trimester has thoracic back pain and highly suspected aortic dissection, CTA should be performed to avoid missed diagnosis, misdiagnosis and diagnostic delay. Once diagnosed, maternal survival should be prioritized over fetal concerns. TEVAR is safe and feasible for such patients. For complicated TBAD in the third trimester single-stage delivery and TEVAR are preferred, and TEVAR followed by cesarean section performed in one operative session is the treatment of choice.

Objective This study aimed to comprehensively evaluate the clinical characteristics of COVID-19 in perinatal period, and systematically assess the mother-to-child transmission potential of SARS-CoV-2. Design A case retrospective study. Setting and Population We retrospectively analyzed the data of 23 pregnant patients in late pregnancy. Methods Maternal and neonatal throat swabs, vaginal secretions, placenta tissues, and breast milk, were collected for the nucleic acid test of the virus. Pregnancy outcomes and neonatal results were also analyzed. Main Outcome Measures The result of viral nucleic acid test and pregnancy outcomes. Results Overall, 10 patients (43.5%) had no symptoms and were found by routine chest CT. Complications appeared after COVID-19 onset included PROM (17.4%) and fetal distress (4.3%). Typical signs of viral pneumonia were recorded in chest CT of all patients. No patients developed severe pneumonia or died of COVID-19. All of 25 neonates were born alive. No severe asphyxia or neonatal death was observed. Although three neonates were tested transiently suspected positive for SARS-CoV-2 after being transferred to neonatology department, no newborns developed COVID-19. Only a rectal swab sample from one pregnant patient was tested positive for SARS-CoV-2, while all the other clinical specimens including first sample of newborn throat swabs were negative. Pathological examination found no obvious chorioamnionitis or clear virus inclusion body in placenta, and ACE2 (angiotension-converting enzyme 2) was expressed at a moderate level. Conclusions Asymptomatic patients were present in pregnant women. There is no confirmatory evidence for mother-to-child transmission in COVID-19 patients with late pregnancy.