Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

The differential diagnosis of pre-eclampsia should include the association of severe hypertension and aortic dissection

Oscar Jolobe
Download PDF
DOI: https://doi.org/10.7861/clinmed.Let.22.1.1
Clin Med January 2022
Oscar Jolobe
Manchester, UK
Roles: Retired geriatrician
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
Loading

Editor – When severe hypertension in pregnancy is defined as a sustained systolic blood pressure of ≥160 mmHg or a diastolic blood pressure of ≥110 mmHg, related disorders that should be considered include not only pre-eclampsia but also dissecting aortic aneurysm (DAA), a disorder sometimes misdiagnosed as pre-eclampsia when it presents with hypertension.1,2

In one report, a 29-year-old primigravida woman presented at 37 weeks gestation with a blood pressure of 160/110 mmHg and a 24-hour urinary protein of 2,462 mg. She was given a diagnosis of severe eclampsia.2 She received antihypertensive treatment and her baby was delivered by caesarean section. Six days later, she experienced severe back pain radiating to the chest, her blood pressure on that occasion was 190/100 mmHg. She was initially diagnosed with postpartum eclampsia in spite of persisting severe back pain and chest pain. Subsequent computed tomography with angiography showed type B aortic dissection. As a result of appropriate operative intervention, she made a complete recovery.

The association of severe hypertension and pregnancy-related DAA can also occur in the context of conventional risk factors for DAA (such as Marfan's syndrome), exemplified by a 24-year-old woman with clinical stigmata of Marfan's syndrome and a blood pressure of 174/110 mmHg during pregnancy.3 She had a fatal DAA postpartum.

Key points

  • The differential diagnosis of pre-eclampsia should include DAA whenever symptoms of DAA occur in a patient with a provisional diagnosis of pre-eclampsia. This differential diagnosis should prevail during pregnancy and also during the puerperium.

  • A pregnant woman with severe hypertension should also be evaluated for stigmata of Marfan's syndrome and for stigmata of coarctation of the aorta.

  • © Royal College of Physicians 2022. All rights reserved.

References

  1. ↵
    1. Wiles K
    , Damodaram M, Frise C. Severe hypertension in pregnancy. Clin Med 2021;21;e451–6.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Huang J
    , Liu H, Ding Y-l. Two cases of acute aortic dissection following preclampsia in non-Marfan patients. Chinese Medical Journal 2012;125:2073–5.
    OpenUrlPubMed
  3. ↵
    1. Moore HC
    . Marfan's syndrome, dissecting aneurysm of the aorta, and pregnancy. J Clin Path 1965;18:277–81.
    OpenUrlAbstract/FREE Full Text
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
The differential diagnosis of pre-eclampsia should include the association of severe hypertension and aortic dissection
Oscar Jolobe
Clinical Medicine Jan 2022, 22 (1) 92; DOI: 10.7861/clinmed.Let.22.1.1

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
The differential diagnosis of pre-eclampsia should include the association of severe hypertension and aortic dissection
Oscar Jolobe
Clinical Medicine Jan 2022, 22 (1) 92; DOI: 10.7861/clinmed.Let.22.1.1
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Key points
    • References
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • The association of pleural effusion and pulmonary embolism
  • COVID-19 pneumonia as a risk factor for recurrent pneumothorax
  • The association of pleural effusion and pulmonary embolism
Show more Letters to the editor

Similar Articles

FAQs

  • Difficulty logging in.

There is currently no login required to access the journals. Please go to the home page and simply click on the edition that you wish to read. If you are still unable to access the content you require, please let us know through the 'Contact us' page.

  • Can't find the CME questionnaire.

The read-only self-assessment questionnaire (SAQ) can be found after the CME section in each edition of Clinical Medicine. RCP members and fellows (using their login details for the main RCP website) are able to access the full SAQ with answers and are awarded 2 CPD points upon successful (8/10) completion from:  https://cme.rcplondon.ac.uk

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians