{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T10:35:32Z","timestamp":1774262132406,"version":"3.50.1"},"reference-count":34,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2015,7,24]]},"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To conduct the first population-level incidence study of aortic dissection in pregnancy using linked hospital-based data in England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Hospital-based data (Hospital Episode Statistics (HES) linked with mortality data from the Office of National Statistics), national enquiries (Confidential Enquiries into Maternal Mortality) and surveys (UK Obstetric Surveillance System; UKOSS) of aortic dissection in pregnancy from 2003 to 2011 in England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Between 2003 and 2011, all female patients admitted with diagnoses of aortic dissection (not necessarily as the primary cause of admission) and of pregnancy, childbirth and puerperium, were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Diagnosis of aortic dissection during pregnancy, operated or not operated, with outcome of death or live patient from 2003 to 2011 in England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were significant differences in characteristics of databases with respect to study population, time of study, recorded event and follow-up of outcomes. On the basis of HES, annual incidence of aortic dissection was 1.23 (95% CI 1.22 to 1.24) per 100 000 maternities. Incidence of aortic dissection with death within 1 year was 0.30 (0.29 to 0.31) per 100 000 maternities. Incidence of aortic dissection increased from 0.74 (0.73 to 0.75) per 100 000 maternities in 2003\u20132005 to 1.52 (1.51 to 1.53) per 100 000 maternities in 2009\u20132011. In the Confidential Enquiries into Maternal Deaths, incidence of deaths was highest for 2003\u20132005 (0.43\/100 000 maternities) and lowest for 1997\u20131999 (0.21\/100 000 maternities). In the UK Obstetric Surveillance System, national incidence of aortic dissection was 0.80 (0.50 to 1.50) per 100 000 maternities between 2009 and 2011.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The case of aortic dissection in pregnancy illustrates data limitations regarding complications in pregnancy from different sources in the UK, even for a diagnosis with seemingly few alternative coding and diagnostic possibilities. These limitations should be acknowledged when estimating incidence and outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2015-008318","type":"journal-article","created":{"date-parts":[[2015,8,21]],"date-time":"2015-08-21T20:10:34Z","timestamp":1440187834000},"page":"e008318","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Aortic dissection in pregnancy in England: an incidence study using linked national databases"],"prefix":"10.1136","volume":"5","author":[{"given":"Amitava","family":"Banerjee","sequence":"first","affiliation":[{"name":"University of Birmingham Centre for Cardiovascular Sciences, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irena","family":"Begaj","sequence":"additional","affiliation":[{"name":"Quality Outcomes Research Unit, Queen Elizabeth Hospital, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Thorne","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2015,8,20]]},"reference":[{"key":"2025121605365557000_5.8.e008318.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(03)00169-3"},{"key":"2025121605365557000_5.8.e008318.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.000483"},{"key":"2025121605365557000_5.8.e008318.3","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000130644.78677.2C"},{"key":"2025121605365557000_5.8.e008318.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(98)70039-0"},{"key":"2025121605365557000_5.8.e008318.5","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.jtcvs.2014.10.038","article-title":"Perioperative management and outcomes of aortic surgery during pregnancy","volume":"149","author":"Yates","year":"2015","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025121605365557000_5.8.e008318.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2009.10.029"},{"key":"2025121605365557000_5.8.e008318.7","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/0002-9378(49)90726-7","article-title":"Massive aortic dissection (dissecting aneurysm) associated with pregnancy and hypertension","volume":"57","author":"Anderson","year":"1949","journal-title":"Am J Obstet Gynecol"},{"key":"2025121605365557000_5.8.e008318.8","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1097\/00000441-194512000-00003","article-title":"Coarctation and acute dissection of the aorta associated with pregnancy","volume":"210","author":"Kinney","year":"1945","journal-title":"Am J Med Sci"},{"key":"2025121605365557000_5.8.e008318.9","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.ijoa.2014.05.001","article-title":"Outcomes in pregnant women with acute aortic dissections: a review of the literature from 2003 to 2013","volume":"23","author":"Rajagopalan","year":"2014","journal-title":"Int J Obstet Anesth"},{"key":"2025121605365557000_5.8.e008318.10","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1111\/j.1471-0528.2011.03178.x","article-title":"Maternal mortality attributable to vascular dissection and rupture in the Netherlands: a nationwide confidential enquiry","volume":"119","author":"la Chapelle","year":"2012","journal-title":"BJOG"},{"key":"2025121605365557000_5.8.e008318.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2010.12.070"},{"key":"2025121605365557000_5.8.e008318.12","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2011.09.005"},{"issue":"(Suppl 4)","key":"2025121605365557000_5.8.e008318.13","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/1471-0528.12820","article-title":"Experiences with maternal and perinatal death reviews in the UK\u2014the MBRRACE-UK programme","volume":"121","author":"Kurinczuk","year":"2014","journal-title":"BJOG"},{"key":"2025121605365557000_5.8.e008318.14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2012.03330.x"},{"key":"2025121605365557000_5.8.e008318.15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e4147"},{"key":"2025121605365557000_5.8.e008318.16","doi-asserted-by":"publisher","DOI":"10.1177\/1741826711432117"},{"key":"2025121605365557000_5.8.e008318.17","unstructured":"Knight M , McClymont C , Fitzpatrick K , et al . on behalf of UKOSS. 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