Objective: Pregnancy with complicated type B aortic dissection is a rare but devastating scenario. And there are no definitive guidelines for management and therapy. We report our exploration and experiences of managing five pregnant with complicated TBAD in the second or third trimesters, aiming to propose an appropriate management strategy. Design: Retrospective study. Setting: Zhongnan Hospital of Wuhan University. Population: Pregnant women with TBAD Methods: The clinical data of 5 pregnant women with TBAD who were admitted to the Zhongnan Hospital of Wuhan University from January 2022 to June 2023 were collected. The clinical features, diagnostic procedures, treatment strategies and corresponding maternal and infant outcomes were retrospectively analyzed. Main Outcome Measures: The survival of mother and fetus. Result: All five pregnant women with TBAD were diagnosed with complicated TBAD. The average age of the patients was (34.8±8.13) years, and the range of gestational weeks at admission was 27 weeks plus 3 days to 36 weeks plus 6 days. The first patient intending to receive a cesarean section and subsequent TEVAR died of rupture of aortic dissection during cesarean section. Her neonate was successfully rescued. The remaining four patients who underwent TEVAR first survived. Three underwent single-stage aortic repair and delivery, and one patient underwent cesarean section 27 days after TEVAR. Three preterm live births of these four patients were recorded. During late follow-up, no maternal and fetal deaths occurred. Neither device-related nor systemic complications post TEVAR were observed in the mother. Routine physical examinations of four live births showed no abnormalities. Conclusion: When a pregnant woman in the second or third trimester has thoracic back pain and highly suspected aortic dissection, CTA should be performed to avoid missed diagnosis, misdiagnosis and diagnostic delay. Once diagnosed, maternal survival should be prioritized over fetal concerns. TEVAR is safe and feasible for such patients. For complicated TBAD in the third trimester single-stage delivery and TEVAR are preferred, and TEVAR followed by cesarean section performed in one operative session is the treatment of choice.