The Royal Department of Obstetrics and Gynecology of North Medical College was occupied by 50 medical disturbances yesterday, and the female scientist of Chinese Academy of Sciences unfortunately passed away. The Institute of Physics and Chemistry of Chinese Academy of Sciences issued official documents to deal with North Medical College head-on. The net rumor is that the mother died of aortic coarctation. Think of all the fear, we have encountered a similar situation ah! I remember one winter 8 years ago, when I was still working in the emergency center, in the middle of the night came a pregnant woman of about 30 years old, 3 months pregnant, also belonged to the kind of good pregnancy, so the family is more baby, severe pregnancy vomiting 3 days! When I saw this patient, I didn’t think it was a big deal, it was just a case of vomiting. Who doesn’t throw up when pregnant? But since she was here, she should do some routine tests that are not harmful to the fetus, such as routine blood tests, liver and kidney functions, electrolytes, blood and urine amylase, and abdominal ultrasound, all of which showed no significant abnormalities. But once the blood pressure was taken, something was wrong. We know that when measuring blood pressure, press the radial artery with your hand, send air to the cuff, wait until the arterial beat disappears, then pressurize 20 – 30 cm Hg to stop inflation, then slightly open the air valve, so that the mercury column slowly decreases, and the first pulse beat heard is the systolic pressure (upper pressure), and the last pulse sound heard is the diastolic pressure (lower pressure). This pregnant woman, when her blood pressure was measured, the mercury column at “0”, you can still hear the sound, indicating that the pregnant woman’s diastolic pressure is 0, which is very rare in young women. When listening carefully to the pregnant woman’s heart, a breath-like diastolic murmur was heard in the aortic valve auscultation area, which basically determined that the pregnant woman had severe aortic valve insufficiency. But what causes severe aortic valve insufficiency at such a young age? Cardiac ultrasound is the gold standard for detecting aortic valve insufficiency. This patient’s cardiac ultrasound did suggest severe aortic valve insufficiency, and it appeared that the torn endothelial surface of the aorta was visible. What a bolt from the blue, such a young pregnant woman could have severe aortic valve insufficiency due to a combined aortic coarctation, what does this mean for the family? If we had to choose between the baby and the pregnant woman, we would have to sacrifice the unformed fetus. Only a CT thoracoabdominal arteriogram can clarify whether the pregnant woman has aortic coarctation. Once the decision is made to perform a CT thoracoabdominal arteriogram, it means that the fetus will be abandoned. With full communication with the patient and family, the patient and family agreed to perform thoracic and whole abdominal CTA. Unfortunately, the pregnant woman was finally diagnosed with “aortic coarctation”, and the CT 3D reconstruction image showed that the whole aorta was torn throughout, and her condition was very critical, or as the people usually say, “Ah! The disease is gone in a flash. The pregnant woman was transferred to the thoracic surgery ward, and the next day she just “ah”, she was gone …… family’s grief can be imagined ah! Imagine, the aorta is like the largest and most important “water pipeline” supplying organs and tissues throughout the body, once ruptured, the blood flows instantly, blood pressure instantly becomes ‘0’, there is no chance of successful resuscitation. Many times I have encountered such patients in the emergency room, preparing for surgery, and before they could get on the table, the patient just “ah” and died. But I used to see that aortic coarctation is often seen in cases of long-term uncontrolled hypertension and atherosclerosis, but this pregnant woman did not have hypertension and was so young, her blood lipids were not high and she did not have atherosclerosis, so how did she get aortic coarctation? Fate is so unfair! In fact, this patient has “Marfan’s syndrome”, which has a high natural mortality rate and is prone to aortic coarctation in the third trimester and the second trimester in female patients. Since Marfan’s syndrome is a relatively rare genetic disorder, and gestational hypertension, preeclampsia, and severe elevation of blood pressure can also lead to aortic coarctation, the following conditions are again prohibited: (1) pulmonary hypertension from any cause; (2) severe cardiac insufficiency (left ventricular ejection fraction <30%); (3) severe mitral and aortic stenosis; (4) Marfan's syndrome (4) Marfan's syndrome with aortic dilatation ≥45 mm; (5) bilobed aorta with aortic dilatation ≥50 mm; (6) severe congenital aortic constriction. Pregnant women with severe hyperemesis, pre-eclampsia and eclampsia should be prohibited from blind fetal preservation, and rapid termination of pregnancy is the only possible way to preserve the adult! I've said the important things more than three times! I hope that a tragedy will not be repeated!