Pulseless disease

Maternal and Neonatal Outcomes in 89 Patients with Takayasu Arteritis (TA): Comparison Before and After the TA Diagnosis

Objective.

To evaluate maternal and neonatal outcomes in patients before and after a diagnosis of Takayasu arteritis (TA).

Methods.

Patients diagnosed with TA according to the American College of Rheumatology criteria were selected from the Vasculitis Outpatient Clinic of the Rheumatology Division. Healthy female staff members of this hospital of similar age and educational level were selected as the controls. The disease data were obtained from an ongoing electronic database protocol. A standardized questionnaire, emphasizing gestational history, was applied to both groups. The prevalence of fetomaternal complications and disease variables were evaluated between the groups and a statistical analysis was performed.

Results.

A total of 89 patients with TA (156 pregnancies) and 89 healthy controls (181 pregnancies) were evaluated. There were 75.6% pregnancies that occurred before the TA diagnosis (pre-TA group) and 24.3% after (post-TA group). In the pre-TA group, higher rates of hypertension (HTN; 27.1% vs 3.9%, p < 0.001), low birth weight (16.8% vs 6.5%, p = 0.012), and perinatal mortality (7.9% vs 0.7%, p = 0.003) were observed compared with healthy controls. The frequency of abortions and the average number of children were similar in both groups (p > 0.05). Further comparison of the pre- and post-TA groups revealed similar rates of HTN, abortion, and low birth weight, and higher rates of Cesarean delivery (p = 0.002), prematurity (p < 0.001), and infection (p = 0.045) in the latter group.

Conclusion.

Our study identified that patients with TA, even before the disease diagnosis, have a worse fetal outcome that is most likely associated with high rates of HTN. TA was identified as an additional differential diagnosis for HTN in pregnancy.

Successful outcome of pregnancy in a subfertile patient with severe aortoarteritis (Takayasu's disease)

This report describes the successful outcome of pregnancy in a 27-yr-old subfertile Chinese nullipara with severe Takayasu's disease. Pregnancy was achieved following ovulation induction with clomiphene. Blood pressure was controlled with propranalol and fetal growth was monitored by serial ultrasound fetal anthropometry. Pregnancy was terminated at 38 weeks of pregnancy by elective caesarean section. A live female infant weighing 2420 g was delivered.

Occlusive thromboaortopathy (Takayasu's disease) and pregnancy. Clinical course and management of 33 pregnancies and deliveries

Twenty-seven Japanese patients with occlusive thromboaortopathy (Takayasu's disease) associated with 33 pregnancies and deliveries were followed up prospectively, from the prepregnant period. Inflammatory activity of the disease was apparently not enhanced by the pregnancy, but various cardiovascular-related events occurred in the perinatal period. During the intrapartum uterine contractions, marked elevation of systolic blood pressure was associated with 10 pregnancies, including 1 case of subsequent cerebral hemorrhage; this did not occur in 13 normal control gravidas. There were no maternal or neonatal deaths. The birth weight of 25 infants of 21 patients without complications or with a mild single complication of Takayasu's disease was 3,023 +/- 442 g (mean +/- standard deviation). The birth weight of 8 infants of 6 patients who had a severe single complication or multiple complications of the disease was 2,599 +/- 394 g (p less than 0.05). Of 83 pregnancies, the present 33 plus 50 other reported cases there were no un-toward events in two fifths. Three fifths had various problems, most of which were related to pressure elevation and heart failure, including intrapartum cerebral hemorrhage in 4. These data should assist in predicting the outcome of pregnancy and delivery in patients with Takayasu's disease.