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.Ignatko I.V., Bogomazova I.M., Timokhina E.V., Belousova V.S., Muravina E.L., Samoylova Yu.A., Rasskazova T.V., Makarova M.A.
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.
Authors' contributions: Ignatko I.V., Timokhina E.V., Belousova V.S., Muravina E.L. – the concept and design of the investigation; Bogomazova I.M., Makarova M.A. – material collection and processing, writing the text; Samoylova Yu.A., Rasskazova T.V. – statistical data processing; Ignanko I.V., Timokhina E.V., Belousova V.S. – editing.
Conflicts of interest: The authors declare that there are no possible conflicts of interest.
Funding: The authors declare that there is no financing.
Patient Consent for Publication: The female patient has signed an informed consent form to the publication of her data.
For citation: Ignatko I.V., Bogomazova I.M., Timokhina E.V., Belousova V.S., Muravina E.L., Samoylova Yu.A., Rasskazova T.V., Makarova M.A. The characteristics of the course and outcomes of pregnancy in Takayasu’s arteritis.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (5): 147-152 (in Russian)
https://dx.doi.org/10.18565/aig.2023.62
Keywords
Takayasu’s arteritis
Takayasu’s disease
nonspecific aortoarteritis
systemic vasculitides
impaired uterine-placental blood flow
fetal growth restriction
References
- Шувалова М.П., Фролова О.Г., Гребенник Т.К., Ратушняк С.С., Гусева Е.В. Экстрагенитальные заболевания как причина материнской смертности. Акушерство и гинекология. 2015; 1: 104-10. [Shuvalova M.P., Frolova O.G., Grebennik T.K., Ratushnyak S.S., Guseva E.V. Extragenital diseases as a cause of maternal death. Obstetrics and Gynecology. 2015; (1): 104-10.(in Russian)].
- Pugh D., Karabayas M., Basu N., Cid M.C., Goel R., Goodyear C.S. et al. Large-vessel vasculitis. Nat. Rev. Dis. Primers. 2022; 7(1): 93.https://dx.doi.org/10.1038/s41572-021-00327-5.
- Zaldivar Villon M.L.F., de la Rocha J.A.L., Espinoza L.R. Takayasu arteritis: recent developments. Curr. Rheumatol. Rep. 2019; 21(9): 45.https://dx.doi.org/10.1007/s11926-019-0848-3.
- Tombetti E., Mason J.C. Takayasu arteritis: advanced understanding is leading to new horizons. Rheumatology (Oxford). 2019; 58(2): 206-19.https://dx.doi.org/10.1093/rheumatology/key040.
- Министерство здравоохранения Российской Федерации. Неспецифический аортоартериит. Клинические рекомендации. М.; 2016. [Ministry of Health of the Russian Federation. Nonspecific aortoarteritis. Clinical guidelines. Moscow; 2016. (in Russian)]. Available at:https://minzdrav29.ru/health/normativnye-pravovye-dokumenty/klinical_protokols/KR479.pdf
- Беженарь В.Ф., Шешко Е.Л., Филиппов О.С., Прялухин И.А., Нестеров И.М., Гриненко Г.В., Шипулина У.А. Результаты мониторинга критических акушерских состояний и итоги аудита случаев near miss в Санкт-Петербурге по данным регистра КАС ВИМИС «АКиНЕО» в 2021 году. Акушерство и гинекология. 2022; 5: 118-27. [Bezhenar V.F., Sheshko E.L., Filippov O.S., Pryalukhin I.A., Nesterov I.M., Grinenko G.V., Shipulina U.A. Results of severe maternal morbidity surveillance and near-miss audit in Saint Petersburg according to the Vertically Integrated Medical Information System of Obstetrics and Gynecology and Neonatology (VIMIS ACU&NEO) Register in 2021. Obstetrics and Gynecology. 2022; (5): 118-27. (in Russian)].https://dx.doi.org/10.18565/aig.2022.5.118-127.
- Keser G., Aksu K., Direskeneli H. Takayasu arteritis: an update. Turk. J. Med. Sci. 2018; 48(4): 681-97. https://dx.doi.org/10.3906/sag-1804-136.
- Misra D.P., Rathore U., Patro P., Agarwal V., Sharma A. Disease-modifying anti-rheumatic drugs for the management of Takayasu arteritis-a systematic review and meta-analysis. Clin. Rheumatol. 2021; 40(11): 4391-416.https://dx.doi.org/10.1007/s10067-021-05743-2.
- Бекетова Т.В., Попов И.Ю., Зеленов В.А. Обзор рекомендаций American College of Reumatology/Vasculitis Foundation по лечению системных васкулитов крупных сосудов (гигантоклеточного артериита и артериита Такаясу). Научно-практическая ревматология. 2022; 60(2): 165-73. [Beketova T.V., Popov I.Yu., Zelenov V.A. Review of guideline for the management of large vessel vasculitis presented in 2021 by the American College of Rheumatology/Vasculitis Foundation. Rheumatology Science and Practice. 2022; 60(2): 165-73. (in Russian)]. https://dx.doi.org/10.47360/1995-4484-2022-165-73.
- Dalkilic E., Coskun B.N., Yağız B., Pehlivan Y. A successful pregnancy in a patient with Takayasu's arteritis under tocilizumab treatment: A longitudinal case study. Int. J. Rheum. Dis. 2019; 22(10): 1941-4. https://dx.doi.org/10.1111/1756-185X.13687.
- Dey M., Kapur A., Goyal S., Wadhwa R.D., Srivastava A., Agarwal R. Takayasu arteritis in pregnancy. Med. J. Armed Forces India. 2015 Jul; 71(Suppl. 1):S227-9. https://dx.doi.org/10.1016/j.mjafi.2014.04.013.
- Cухих Г.Т., Ванько Л.В. Иммунные факторы в этиологии и патогенезе осложнений беременности. Акушерство и гинекология. 2012; 1: 128-36. [Sukhikh G.T., Vanko L.V. Immune factors in the etiology and pathogenesis of pregnancy complications. Obstetrics and Gynecology. 2012; (1): 128-36. (in Russian)].
- Comarmond C., Mirault T., Biard L., Nizard J., Lambert M., Wechsler B. et al.; French Takayasu Network. Takayasu arteritis and pregnancy. Arthritis Rheumatol. 2015; 67(12): 3262-9. https://dx.doi.org/10.1002/art.39335.
- Gudbrandsson B., Wallenius M., Garen T., Henriksen T., Molberg Ø., Palm Ø. Takayasu arteritis and pregnancy: a population-based study on outcomes and mother/child-related concerns. Arthritis Care Res. (Hoboken). 2017; 69(9): 1384-90. https://dx.doi.org/10.1002/acr.23146.
- He S., Li Z., Zhang G., Song Y., Li J., Yang Y. et al. Pregnancy outcomes in Takayasu arteritis patients. Semin. Arthritis Rheum. 2022; 55: 152016.https://dx.doi.org/10.1016/j.semarthrit.2022.152016.
- Clowse M.E., Richeson R.L., Pieper C., Merkel P.A.; Vasculitis Clinical Research Consortium. Pregnancy outcomes among patients with vasculitis. Arthritis Care Res. (Hoboken). 2013; 65(8): 1370-4. https://dx.doi.org/10.1002/acr.21983.
- Kirshenbaum M., Simchen M.J. Pregnancy outcome in patients with Takayasu's arteritis: cohort study and review of the literature. J. Matern. Fetal Neonatal Med. 2018; 31(21): 2877-83. https://dx.doi.org/10.1080/14767058.2017.1359529.
- Bharuthram N., Tikly M. Pregnancy and Takayasu arteritis: case-based review. Rheumatol. Int. 2020; 40(5): 799-809. https://dx.doi.org/10.1007/s00296-019-04499-y.
- Arezzo F., Venerito V., Iannone F., Lombardi C. Management of Takayasu arteritis diagnosed during pregnancy: a case report. Arch. Rheumatol. 2020; 36(1): 138-9. https://dx.doi.org/10.46497/ArchRheumatol.2021.8023.
- Comarmond C., Saadoun D., Nizard J., Cacoub P. Pregnancy issues in Takayasu arteritis. Semin. Arthritis Rheum. 2020; 50(5): 911-4.https://dx.doi.org/10.1016/j.semarthrit.2020.08.001.
Received 09.03.2023
Accepted 15.03.2023
About the Authors
Irina V. Ignatko, Dr. Med. Sci., Corresponding Member of the Russian Academy of Sciences, Professor of the Russian Academy of Sciences, Professor,Head of the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), +7(499)782-30-45, ignatko_i_v@staff.sechenov.ru,
119991, Russia, Moscow, Trubetskaya str., 8-2.
Irina M. Bogomazova, PhD, Associate Professor at the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine,
I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), +7(926)305-04-03,
bogomazova_i_m@staff.sechenov.ru, https://orcid.org/0000-0003-1156-7726, 119991, Russia, Moscow, Trubetskaya str., 8-2.
Elena V. Timokhina, Dr. Med. Sci., Associate Professor, Professor at the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), +7(499)782-30-45,
timokhina_i_m@staff.sechenov.ru, 119991, Russia, Moscow, Trubetskaya str., 8-2.
Vera S. Belousova, Dr. Med. Sci., Associate Professor, Professor at the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University),
+7(499)782-30-45, belousova_v_s@staff.sechenov.ru, 119991, Russia, Moscow, Trubetskaya str., 8-2.
Elena L. Muravina, PhD, Deputy Chief Physician for Obstetrics and Gynecology, S.S. Yudin City Clinical Hospital, Moscow City Health Department,
+7(499)782-30-64, gkb-yudina@zdrav.mos.ru,115446, Russia, Moscow, Kolomensky proezd, 4.
Yulia A. Samoylova, PhD, Head of the Department of Pregnancy Pathology No. 1, Maternity Hospital of the S.S. Yudin City Clinical Hospital, Moscow City Health Department, +7(499)782-30-64, gkb-yudina@zdrav.mos.ru, 115446, Russia, Moscow, Kolomensky proezd, 4.
Tatyana V. Rasskazova, obstetrician-gynecologist at the Department of Pregnancy Pathology No. 1, Maternity Hospital of the S.S. Yudin City Clinical Hospital, Moscow City Health Department, +7(499)782-30-64, gkb-yudina@zdrav.mos.ru, 115446, Russia, Moscow, Kolomensky proezd, 4.
Marina A. Makarova, student of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), +7(499)782-30-45, doctor_makarova@mail.ru, 119991, Russia, Moscow, Trubetskaya str., 8-2.
Corresponding author: Irina M. Bogomazova, bogomazova_i_m@staff.sechenov.ru
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