Background <p>Acute Stanford type A aortic dissection in late pregnancy is rare but life-threatening, and Neri type C avulsion of the right coronary artery further increases perioperative risk. This case highlights the importance of early recognition and coordinated sequential management.</p> Case presentation <p>A 24-year-old woman at 38 weeks and 3 days of gestation presented with sudden chest and back pain. Echocardiography and aortic magnetic resonance imaging confirmed acute Stanford type A aortic dissection with suspected branch-vessel involvement. After multidisciplinary assessment, she underwent lower-segment cesarean delivery with obstetric hemostatic procedures, followed by Sun procedure, ascending aortic replacement, and coronary artery bypass grafting for Neri type C avulsion of the right coronary artery. The mother and infant recovered well, and no recurrent symptoms were observed during follow-up.</p> Conclusions <p>In late pregnancy, sudden chest and back pain should prompt evaluation for acute aortic dissection, especially when vascular or echocardiographic warning signs are present. In this high-risk case, timely multidisciplinary sequencing of cesarean delivery, obstetric hemostasis, and aortic repair was critical to achieving favorable maternal and neonatal outcomes.</p>