Two lives on the line: a case study in obstetric critical care.

To purchase reprints, contact The innoVisinn Group, 101 Columhia,AhsoViejo,CA 92656, Phone, (800) 809-2273 or (9491 362-2030 (ext 532); iax, (949) 362-2049: e-mail, he physiological changes of pregnancy can greatly exaggerate preexisting health conditions in the mother. One such condition is Marfan syndrome, a genetically inherited disorder characterized hy weakened connective tissue. Persons with Marfan syndrome are very tall with disproportionately long extremities and are characterized by arachnodactyly and lax joints predisposed to dislocation. Marfan syndrome can lead to dislocation of the ocular lens, as well as weakness of the aortic root and aortic wall.' The danger of aortic dissection in women with Marfan syndrome can he compounded by the hemodynamic changes of pregnancy. In pregnant women with Marfan syndrome, the highest risk for aortic dissection is from the beginning of the third trimester until shortly after delivery.' Aortic dissection during pregnancy is an emergency that endangers the lives of both motlier and fetus. We describe the successful medical and surgical management of a pregnant woman with Marfan syndrome. The complicated psychosocial issues associated with high-risk pregnancy and delivery and the need for accurate interdisciplinary communication are discussed.