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Abdominal aortic aneurysm in pregnant crack cocaine abuse patient. Shiraz E-Med J. In Dr Nicholls, physician to King George first described on necropsy an aortic dissection 1. Abdominal aortic aneurysm is a limited dilatation of the part of abdominal aorta just below the renal arteries and end above the iliac arteries. May be long up to 25 cm 2. The most common cause for degenerative process is atherosclerosis 3. Chief among risk factors is hypertension 3. Other causes include hereditary connective tissue disorders, aortic arthritis, chest trauma, bicuspid aortic valve 3. Possible other aortic disorders such as giant cell arthritis or systemic lupus also may predispose to dissection. AAA is very rare in young females. Crack cocaine users and pregnant woman are at increased risk of suffering from AAA 4. The cardiovascular complications related with cocaine abuse are adrenergic mediated, vasoconstriction, Include myocardial ischemia, infarction, myocarditis, thrombosis and aortic dissection 6. Cocaine decreases uterine blood flow and induces uterine contractions. It is clear, however, that women who use cocaine during pregnancy are at significant risk for shorter gestations, preterm labor, spontaneous abortions, PROM, abruption placenta, and death 7. Cocaine crosses the human placenta and is associated with free radical production, and fetal encephalopathy. Cocaine has teratogenic or adverse effects on developing brain 7. In this report we present the case of a crack user pregnant woman who develops an aortic aneurysm. The vasoconstriction and sympathomimetic effect of crack, coupled with cardiovascular changing during pregnancy, may predispose the patient to aortic aneurysm. A 32 year old woman who was 40 weeks pregnant with her second pregnancy came to the labor department complaining of labor pain and rupture of membrane. She had a previous cesarean section last year. She abused crack cocaine. She used crack every 2 hours. Physical examination revealed a temperature of An emergency cesarean section was performed; the neonatal was born with 1 minute and 5 minute Apgar score 7 and 9. The infant was transported to the neonatal intensive care unit. Testing for syphilis, hepatitis B surface antigen, human immunodeficiency HIV are non reactive. She was agitated and received 10 mg morphine and 10 mg diazepam in intensive unit. But she was restless and wanted more Illicit drugs. Suddenly blood pressure and pulse rate did not record by pulse oxymetry. The patient was pronounced dead 13 hours after cesarean section in intensive care unit. Her physicians suspected myocardial infarction, cerebral hemorrhage, amniotic fluid embolism or massive pulmonary embolism. Her neonatal suffered from post natal abstinence syndrome and morphine was used as the analgesic and withdrawal drug in NICU. Abdominal aortic aneurysms represent a degenerative process in the media of the arterial wall, resulting in a slow and continuous dilatation of the lumen of the vessel 8 , 9. The aortic wall contains smooth muscle, elastin and collagen arranged in concentric layers in order to withstand arterial pressure 1 , 8 , 9. Elastin is the principal load —bearing element in the aorta. Elastin degeneration and fragmentation are observed in aneurysm wall of aorta Most patient with aortic dissection are predisposed to a weakened or torn aorta to several factors 1 , 3. The most common cause is atherosclerosis 1 , 3 , 8 , 9 , Other causes include hereditary connective tissue disorders, such as Marfan and Ehlers-Danlos syndromes, granulomatous vasculitis of the aorta, chest trauma caused by a motor-vehicle accident, Turner syndrome 1 - 3 , 8 , 9 , Another risk factor for aortic dissection is the use crack cocaine in pregnant woman 3 , The proposed mechanism of aortic dissection during cocaine abuse is mediated through catecholamine-induced, vasoconstriction, acute profound elevation of heart rate, BP and myocardial contractility causing a rapid rise in the derivative of pressure on the aortic wall resulting intima tear 14 , Cardiovascular changes during pregnancy are: increased stroke volume, blood volume, heart rate, cardiac output and increase in the left ventricular wall mass 2. The increased production of estrogens, prostacyclins, nitric oxide contributes to a decrease in peripheral vascular resistance in aortic compliance 2. Nitric oxide is involved in the progression of AAA Rupture of the aorta in pregnancy usually occurs when blood volume and cardiac output are rising to a maximum. It has been known to occur at all stages of pregnancy and during the weeks after delivery. Cocaine use and activities that cause sudden rise in blood pressure such as weight lifting have been implicated 4. High blood pressure generated during weight changing, an increased ventricular ejection forces, accompanied by the Valsalva maneuver may be the cause of aortic dissection 5 , 9. Most people with AAA have no symptoms unless the aneurysm ruptures. Occasionally AAA can produce abdominal or back pain, or a tender spot in the abdomen 1 , 3 , 8 , 9 , Rupture of an AAA usually causes massive internal bleeding and is often quickly fatal 17 , Patients may have normal vital signs in the presence of ruptured AAA due to retroperitoneal containment of hematoma. Presence of a pulsatile abdominal mass is virtually diagnostic but is found in less than half of cases. The diagnosis may be confused with renal calculus, diverticulitis, incarcerated hernia, or lumbar spine disease 1 , 3 , 8 , 9 , 12 , AAA also are less common in women than in men, and , as with coronary heart disease, there is evidence that women with AAA also have a worse prognosis. AAA in pregnancy is uncommon and occurs in the late stage of pregnancy. Complication related to cocaine abuse includes myocardial ischemia, thrombosis, aortic dissection, sudden cardiac death. Crack cocaine smoking cessation, healthy lifestyle, preconception counseling and prenatal care are associated with lower risk of maternal mortality 2 , 22 , Acute aortic syndromes. Obstetricia de Williams. McGraw Hill Brasil; Nicholas B. Aortic Dissection receives new attention following sudden death of Actor John Ritter. Clinical Lab products. Robinson R. Aortic aneurysm in pregnancy: a case study. Dimensions of Critical Care Nursing. Aortic dissection during pregnancy. British heart journal. Cardiovascular complications of cocaine: Imaging findings. Emergency radiology. Weiner CP, Buhimschi C. Drugs for pregnant and lactating women. Elsevier Health Sciences; Journal of the American College of Cardiology. Clinical, diagnostic, and management perspectives of aortic dissection. Chest Journal. Collagen degradation in the abdominal aneurysm: a conspiracy of matrix metalloproteinase and cysteine collagenases. The American journal of pathology. Abdominal aortic aneurysm the prognosis in women is worse than in men. Braverman AC. Acute Aortic Dissection Clinician Update. Acute aortic dissection related to crack cocaine. Acute aortic dissection—vascular emergency with numerous pitfalls. Emergency abdominal aortic aneurysm presenting without haemodynamic shock is associated with misdiagnosis and delay in appropriate clinical management. Emergency Medicine Journal. Glauser J. Aortic Dissection: The Great Imitator. Emergency Medicine News. Clinical features and diagnosis of abdominal aortic aneurysm. International Journal of Drug Policy. Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. Journal of vascular surgery. We use cookies to provide you with the best possible experience. They also allow us to analyze user behavior in order to constantly improve the website for you. Navigate to Shiraz E-Medical Journal. Abdominal aortic aneurysm in pregnant crack cocaine abuse patient authors:. Shiraz E-Medical Journal: Vol. Abstract Back ground: Rupture is a fatal complication of abdominal aortic aneurysm. An aneurysm is defined as ruptured when bleeding is present outside of the wall of the aneurysm. Case presentation: A 32 year old woman crack user, in 40 weeks pregnancy came to labor department. An emergency cesarean section was performed. She expired 13 hours after surgery. Autopsy detects dissection of abdominal aortic aneurysm. Conclusion: Sympathetic agonist and vasoconstriction effect of crack resulting increased blood pressure, heart rate, myocardial contractility would increase the risk of aortic dissection. Introduction In Dr Nicholls, physician to King George first described on necropsy an aortic dissection 1. Case study A 32 year old woman who was 40 weeks pregnant with her second pregnancy came to the labor department complaining of labor pain and rupture of membrane. She did not receive adequate prenatal care in this pregnancy. The patient was pronounced dead 13 hours after cesarean section in intensive care unit Her physicians suspected myocardial infarction, cerebral hemorrhage, amniotic fluid embolism or massive pulmonary embolism. Discussion Abdominal aortic aneurysms represent a degenerative process in the media of the arterial wall, resulting in a slow and continuous dilatation of the lumen of the vessel 8 , 9. Conclusions AAA also are less common in women than in men, and , as with coronary heart disease, there is evidence that women with AAA also have a worse prognosis. References 1. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4. Leave a comment here:. Cookie Setting We use cookies to provide you with the best possible experience.
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Just a few days later, police in the United Kingdom seized more than two tons of the drug — one of the country's largest ever single busts.
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Shiraz Ahmadzai, aged 19, from Cobden Avenue, Southampton was jailed at Southampton Crown Court today (7 September) after pleading guilty to three counts of.
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