A Systematic Review and Meta-Analysis of Presentation, Management, and Outcomes of Type B Aortic Dissection in Pregnancy.

INTRODUCTION: Acute aortic dissection is rare but potentially catastrophic complication of pregnancy. The primary aim of this systematic review was to determine the mortality rates and most common treatment modalities in pregnant patients with type B aortic dissection. The secondary aim was to characterise the presentation of type B aortic dissection during pregnancy. METHODS: The protocol for this review was registered on PROSPERO (CRD420251173789). Electronic databases were searched to the 21st of October 2025. Studies reporting on pregnant or postpartum women diagnosed with an acute type B aortic dissection were included. A random-effects meta-analysis was performed to calculate gestational age at diagnosis, treatment modality and mortality rates. RESULTS: 331 records were screened in the initial search. A total of eight studies satisfied the inclusion criteria, evaluating 409 patients. Most patients were diagnosed with a type B aortic dissection during the third trimester (40.3%, 95% CI: 17.2 - 60.9%, I2 = 53.7%). An endovascular approach was followed to treat 39.7% of patients (95% CI: 6.4 - 72.6%, I2 = 80.4%). Average maternal mortality was 8.2% (95% CI: 5.7 - 11.0%) and foetal mortality was 37.8% (95% CI: 20.4 - 56.7%) (I2 = 35.5%). Evidence was low in quality. CONCLUSIONS: Type B aortic dissection in pregnancy is associated with high rates of maternal and foetal mortality. A multidisciplinary approach is required to deliver tailored treatment considering patient presentation, gestational age, and patient choices. Large registry studies are required to better characterise treatment outcomes of type B aortic dissection in pregnancy and to inform future guidelines.