The characteristics of the course and outcomes of pregnancy in Takayasu’s arteritis

Background: Takayasu’s arteritis (TA) is assigned to systemic vasculitides and is an autoimmune lesion of large vessels, which affects the aorta and its branches; occurs manly in reproductive-aged females. Hypertensive events, premature termination of pregnancy, placental insufficiency, and fetal growth restriction are more commonly observed in pregnant women with TA than in the population. To improve maternal and perinatal outcomes, there is a need to carefully monitor the activity of TA during pregnancy and at the pregravid stage.

Case report: A thirty-year old female patient was delivered to a hospital at 29 weeks’ gestation with complaints of pressing pains behind the sternum, which irradiate to the left arm. Three years before, AT affecting the brachiocephalic arteries and thoracic aorta was diagnosed. During admission examination, pulsation of radial and temporal arteries on the left was not detected; it on the right was weakened. Left blood pressure was not recorded; right one was 128/85 mm Hg. Electrocardiography could not reveal focal coronary symptoms. The troponin test was negative. C-reactive protein was 140.4 mg/ml. Duplex vascular scanning established stenosis of brachiocephalic and renal arteries. Uterine echographic examination revealed fetal growth restriction and bilateral impairments of uterine artery blood flow. Specific therapy for TA was resumed in the patient and early delivery was performed.

Conclusion: In this clinical case, acute myocardial damage was excluded in the patient who developed symptoms of the acute coronary syndrome; however, she was found to have a prognostically unfavorable impairment of uterine-placental blood flow with the development of fetal growth restriction, as well as renal dysfunction. Pregnancy in the presence of TA is a high-risk pregnancy and requires close collaboration and succession of specialists of different profile.