**3.9 Pregnancy and delivery**

Both pregnancy and delivery are independent risk factors for aortic dissection [13], but with the presence of other connective tissue diseases like Marfan's syndrome or bicuspid aortic valve, the risk usually multiplies. In pregnancy, aortic dissection occurs most commonly in third trimester due to hyper dynamic metabolic state and hormonal effects on the vasculature.

### **3.10 Fluoroquinolone usage**

Some observational studies relate an increased association of aortic dissection or aneurysm with fluoroquinolone usage [14].
