Takayasu's Arteritis and Pregnancy: A Case Report and Review of Literature

Introduction: Takayasu's arteritis is a nonspecific incessant fiery vasculitis which wrecks huge vascular trunks (aorta and its branches and pneumonic supply routes). Its etiology is not yet explained. It prevalently influences young ladies when it is connected with pregnancy that makes pregnancy at danger due to duplicating maternal and fetal confusions. Objectives: The point of our work is to etudiate the effect of Takayasu's infection on pregnancy; decide the effect of pregnancy on this illness and to propose a pragmatic driving for the prosperity maternal-fetal in the event that this affiliation. Observation: We report the instance of Ms. M.K matured 29 years, nulliparous third act, with a past filled with two restorative premature births. The patient is known Takayasu's sickness quiet from 15 years, at present pregnant with spontaneous pregnancy and counseled surprisingly at 20 weeks of incubation. Our patient has a coarctation of the aorta with serious hypertension. The course of pregnancy was set apart by the diligence of unequal hypertension requiring three hostile to hypertensive medications, and afterward it was pre eclampsia. Concerning the baby; he was in extreme intrauterine development impediment more clear at 30 weeks incubation, requiring a nearby ultrasound checking. Amid the Doppler checking there has been a converse stream showing crisis labor by cesarean segment at 34 weeks. The quick postoperative and medium term outcomes were good. Conclusion: The event of pregnancy in a patient with Takayasu's sickness is an uncommon circumstance that can be set apart by difficulties: pre-eclampsia, the intrauterine development hindrance, the shaky pulse, and heart disappointment. Enhancing maternal-fetal visualization requires a few suggestions.


Introduction
Takayasu's disease is a non specific inflammatory arteritis of large and medium caliber arteries (the aorta and its main branches, the pulmonary arteries) [1].
The incidence of this disease is 1.2 to 2.6 cases/million per year. The sex ratio is in favor of women. They are aged between 20 and 40 and are essentially on age procreating.
The clinical appearances are profoundly polymorphic; they might be asymptomatic as the reason for genuine damage. This ailment regularly develops in two stages, systemic and occlusive. It is described by the demolition of the media of the mass of conduits, consequently prompting the improvement of stenosis or blood vessel anevrysms [2].
The rare association of pregnancy in this pathology makes pregnancy at risk because of higher incidence of maternal and fetal complications.

Case Report
We report the case of Madame M.K aged 29, third gesture nulliparous, reached Takayasu's disease diagnosed at the age of 15. She history as both medically terminated pregnancy in the first quarter.
Her new pregnancy is unplanned; for which she consulted for the first time at 20 weeks gestation. On the maternal side, this patient carries a coarctation of the aorta with severe hypertension with good left ventricular function. During pregnancy, blood pressure figures were disturbed that required the use of three anti-hypertensive. At that HTA has partnered significant proteinuria. Pre-eclampsia has sounded the fetus is due to intrauterine growth retardation, severe uterine. This pregnancy was very high risk of maternal complications and fetal hence was hospitalized women from 27 weeks of gestation under strict supervision. The evolution was marked by the worsening of fetal growth retardation and 34 weeks there was a zero Doppler umbilical which is associated with abnormalities in the recording of fetal heart rate; which led us to extract the fetus emergency. Cesarean section was conducted under spinal anesthesia with immediate postoperative and delayed favorable.

Discussion
Takayasu sickness typically influencing young ladies, pregnancy is not uncommon. In the event that the mother's forecast is not changed by pregnancy, fetal guess depends however particularly the kind of harm maternal vessels [3]. Rupture of the stomach aorta and the renal courses is a critical danger of hypertension, eclampsia and fetal misfortune. In the underlying, dynamic period of the malady, pregnancy can here and there be a contributing element to heart disappointment or fundamental renal capacity. The treatment of hypertension is vital, decreasing additionally the danger of cerebral discharge [4].
Through this case and review of the literature, it appears that pregnancy planning proves paramount. Takayasu's disease should be if possible "non-active" and therapeutic balance pre-and conceptional perished. A comprehensive assessment of this vasculitis procreation is necessary before to detect various violations lesional vessels to discuss the most appropriate treatment. Thereof may be medical or optionally revascularization (angioplasty or surgery).
The fundamental difficulty of this illness amid pregnancy is pre eclampsia (and its inconveniences) up to fetal passing in utero. The platelet collection inhibitors ought to be offered ahead of schedule in pregnancy to diminish this danger in mix with corticosteroids if the infection is in the dynamic stage. Anticoagulants ought not be endorsed to precise premise aside from when vital for another sign.
Bigger scale studies are expected to assess these medicines and enhance the administration of Takayasu infection amid pregnancy. At the point when the treatment is multidisciplinary and that a full evaluation of this malady has been played out, the development of the lion's share of reported pregnancies is for the most part positive for both mother that her embryo.

Conclusion
The event of pregnancy in a patient with Takayasu's is a not a continuous circumstance and which can be set apart by entanglements preeclampsia, the development intrauterine impediment, the unsteady circulatory strain, and heart disappointment.
Improving maternal-fetal prognosis requires some recommendations: • Planning of pregnancy.
• Review complete lesion of disease onset • Monitoring of pregnancy involving cardiologist, gynecologist and obstetrician. • Discuss prescription aspirin if hypertension or female carrier of a vascular prosthesis. • Hospitalization for the 3rd quarter of maternal-fetal monitoring in a level III maternity.