Active Takayasu's arteritis in twin pregnancy: Case report

Abstract

Takayasu's arteritis (TA) is a chronic large-vessel vasculitis of autoimmune etiology. The disease has not been shown to affect fertility in patients with this condition, but TA can be activated during pregnancy and have a significant impact on maternal and fetal health. Its main complications are maternal hypertension, preeclampsia, prematurity, intrauterine growth restriction (IUGR), and low birth weight.

Objective: To describe the follow-up of a twin pregnancy with active TA at 21 weeks' gestation (GS) and its maternal-fetal complications.

Case: A 32-year-old pregnant woman with a prolonged interbirth period (IPP) of 11 years was evaluated in a rheumatology department at 18 weeks, where the diagnosis of TA was confirmed. At 21 weeks, she presented with exacerbation of occipitofrontal headache, retroocular pain, and photophobia. Magnetic resonance angiography (MRA) of intracranial vessels revealed occlusion of the right internal carotid artery at the level of the petrous segment. The activity index was determined using the Indian Takayasu Activity Score (ITAS), with a score of 8. At 35 weeks, a cesarean section and salpingectomy were performed. Premature, low-birth-weight, monochorionic-diamniotic twins were delivered, one of them presented with ABO incompatibility. The patient and the twins' progress was favorable despite the complications.

Conclusions: Pregnant patients with Takayasu's TA have an increased risk of maternal and fetal complications. It is essential to emphasize that management of this condition during pregnancy should be carried out through a multidisciplinary approach.