Management and evaluation of pregnant women with Takayasu arteritis

Tanaçan, Atakan; Ünal, Canan; Yucesoy, Halise Meltem; Duru, Sinem Ayse; Beksaç, Mehmet Sinan

doi:10.1007/s00404-018-4927-x

Cited by 36 publications

(44 citation statements)

References 31 publications

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“…Relapses have also been found to be associated with preeclampsia and growth restriction, which could be the result of impaired placentation and fetal perfusion because of injury to the syncytiotrophoblast, endothelium of spiral veins, endovascular trophoblasts of the spiral arteries and glandular cells of the decidua by autoimmnune inflammatory processes (23). In addition the increase in blood volume and cardiac output during pregnancy can deteriorate the already existing vascular lesions of TA which could be fatal (4,21,24,25). The course of the disease however is not altered by pregnancy (20).…”

Section: Discussionmentioning

confidence: 99%

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Obstetric and perinatal outcomes in pregnant women with Takayasu’s arteritis: single centre experience over five years

David

Beck

Kumar

et al. 2020

J Turkish German Gynecol Assoc

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To study obstetric and perinatal outcomes among pregnant women with Takayasu arteritis (TA), attending our hospital for pregnancy and childbirth between January 2011 to December 2016. Material and Methods: Retrospective study was carried out by abstracting clinical charts on all pregnant women with TA who underwent antenatal care and/or delivery in our hospital during this period. American College of Rheumatology criteria was used for diagnosis of TA. Sixteen women with TA were included in the study. Maternal demographic data, stage of disease, complications related to disease, details of treatment taken prior to pregnancy, pregnancy outcomes, and neonatal outcomes were studied. Results: Forty-four percentage (7/16) belonged to type 5 angiographic type, however the same proportion (7/16) had undergone surgical corrections prior to pregnancy and the majority (15/16) were on medical management. Only three women (19%) were diagnosed during pregnancy. Most did not have active disease measured by Kerr's criteria (n=12; 75%), and Indıan Takayasu clinical activity scores A. Chronic hypertension was the commonest antenatal complication (56.2%), nearly one-third had growth restricted babies and 25% had preterm labour. There were no cardiovascular events, no maternal deaths, nor fetal or neonatal deaths. Two-thirds of our women were delivered by caesarean section. Conclusion: Preconceptional counselling is of paramount importance in women with TA. Good maternal and fetal outcomes are observed with close antenatal surveillance and multidisciplinary care. Pregnancy should be planned during disease remission, with good antenatal care, close monitoring of clinical symptoms, early diagnosis and treatment of complications.

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Section: Discussionmentioning

confidence: 99%

“…Pre-pregnancy counseling to stabilize the disease, is of paramount importance in women with TA (24,25). Presence of chronic hypertension, vasculitis and active disease six months prior to conception are factors associated with poor pregnancy outcomes (26).…”

Section: Discussionmentioning

confidence: 99%

Obstetric and perinatal outcomes in pregnant women with Takayasu’s arteritis: single centre experience over five years

David

Beck

Kumar

et al. 2020

J Turkish German Gynecol Assoc

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“…Autoimmune disorders and diseases resulting in chronic systemic inflammation have been linked with poor obstetric outcomes in various studies . Requirement for medical treatment including biological agents was also found to contribute to poor obstetric outcomes .…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have shown that AS may be associated with adverse pregnancy and neonatal outcomes including preterm labor and small‐for‐gestational age (SGA) fetuses . Furthermore, autoimmunity or autoimmune diseases were also reported to be associated with adverse outcomes …”

Section: Introductionmentioning

confidence: 99%

Retrospective evaluation of pregnancies with ankylosing spondylitis in a tertiary center in Turkey

et al. 2019

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Background To evaluate obstetrical and perinatal outcomes of pregnancies with ankylosing spondylitis (AS). Methods This was a retrospective study evaluating obstetric outcomes of 52 patients with AS who were followed up at our institution between 2006 and 2019. Patients were classified as having disease greater than or less than 5 years, and according to disease‐related medical treatment during pregnancy, as drug free, single medication or multiple medication. Results Overall rates of preterm delivery, intrauterine growth retardation and preeclampsia were 17.3%, 13.4% and 7.7%, respectively. Thirty‐three of the patients were followed up without any medication, while 19 patients used drugs during pregnancy. Seven patients used a single drug and 12 patients had multiple drugs. There was no significant difference in terms of obstetrical and neonatal outcomes. However, a higher rate of neonatal intensive care unit (NICU) admission was observed in the group using medication for AS, despite a lack of statistical significance (31.5% vs 15%, P = .162). On the other hand, patients having disease more than 5 years had higher rates of Apgar scores less than <7 and admission to the NICU despite a lack of statistical significance (4% vs 7.4% and 16% vs 26%; P = .267 and P = .297, respectively). Conclusion In conclusion, pregnancies of patients with AS must be considered as high risk due to increased rates of adverse outcomes such as preterm delivery, intrauterine growth retardation or preeclampsia.

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“…Despite a lack of consensus on the definition of FGR, the most commonly used terminology includes fetuses not reaching their growth potential [1]. FGR is most commonly defined as an estimated fetal weight below the 10 th percentile for the gestational age [2,3].…”

Section: Introductionmentioning

confidence: 99%

A Cut-off Value for Gestational Week at Birth for Better Perinatal Outcomes in Early- and Late-Onset Fetal Growth Restriction

Beksaç

Fadıloğlu

Mamopoulos

et al. 2019

Z Geburtshilfe Neonatol

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Objective Prediction of cut-off value for gestational week at birth for better perinatal outcomes in early- and late-onset fetal growth restriction (FGR). Materials and Methods This study consists of 83 singleton pregnancies with FGR that were diagnosed antenatally and confirmed postnatally between January 2017–April 2018. We used the 34th gestational week as a cut-off for early- and late-onset FGR discrimination. Results Early- and late-onset FGRs were detected in 22 (26.5%) and 61 (73.5%) of the cases, respectively. Expectant management significantly improved birth weight and Apgar scores at the 1st, 5th, and 10th minute in early-onset FGR cases (p=0.001, p=0.019, p=0.002, and p=0.001,respectively). Similar analysis revealed no significant improvements in late-onset FGR (p=0.151, p=0.727, p=0.951 and p=0.477, respectively). Umbilical cord blood gas pH was found to be similar between management modalities in both the early- and late-onset groups (p=0.186 and p=0.456, respectively). Gestational week 33.5 was found to be the threshold for better Apgar scores at the 1st, 5th, and 10th minute according to ROC curve analysis. Percentiles of 4.5, 2.5, and 4.5 were cut-off values for better Apgar scores at the 1st, 5th, and 10th minute, respectively. Conclusion Expectant management must be the first choice to improve Apgar scores in early-onset FGR cases, and gestational week 33.5 must be considered as a threshold for delivery. Immediate delivery might be the choice in late-onset FGR in necessary cases. However, etiology-based management and perinatal surveillance might also be considered to improve prematurity-related neonatal complications.

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Management and evaluation of pregnant women with Takayasu arteritis

Cited by 36 publications

References 31 publications

Obstetric and perinatal outcomes in pregnant women with Takayasu’s arteritis: single centre experience over five years

Obstetric and perinatal outcomes in pregnant women with Takayasu’s arteritis: single centre experience over five years

Retrospective evaluation of pregnancies with ankylosing spondylitis in a tertiary center in Turkey

A Cut-off Value for Gestational Week at Birth for Better Perinatal Outcomes in Early- and Late-Onset Fetal Growth Restriction

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