Also called pulseless disease, this is a chronic inflammatory arteritis afecting large vessels (Goodman, 2014). Unlike temporal arteritis, which develops almost exclusively after age 55, the onset ofTakayasu arteritis is almost always before age 40. It is associated with abnormal angiography of the upper aorta and its main branches and with upper extremity vascular impairment. Death usually results from congestive heart failure or cerebrovascular events. Computed tomography or magnetic resonance angiography can detect this disorder before the development of severe vascular compromise. Takayasu arteritis may respond symptomatically to corticosteroid therapy, however, it is not curative. Surgical bypass or angioplasty improves survival rates.
Comorbid severe renovascular hypertension, cardiac involvement, or pulmonary hypertension worsen pregnancy prognosis (Singh, 2015). Hypertension is relatively common and should be carefully controlled. Blood pressure is most accurately measured in the lower extremity. Overall, the prognosis for pregnancy is good Oohnston, 2002). A study of 58 women with Takayasu arteritis found an elevated risk of pregnancyrelated hypertension and preeclampsia but overall favorable maternal and fetal outcomes (Gudbrandsson, 2017). A study of 52 patients comparing obstetrical outcomes before and ater diagnosis reported higher rates of obstetrical complications after diagnosis. These included preeclampsia, preterm birth, and fetal-growth restriction or death (Comarmond, 2015). Involvement of the abdominal aorta portends worse perinatal outcome (Sharma, 2000). Vaginal delivery is preferred, and epidural analgesia has been advocated for labor and delivery.
Henoch-Schonlein purpura is uncommon after childhood. T ayabali and associates (2012) reviewed 20 pregnancies complicated by this vasculitis and described cutaneous lesions in three fourths. Approximately half had arthralgias. For Beh;et disease, Gungor and colleagues (2014) described 298 pregnancies in 94 women and found higher miscarriage rates and smaller babies compared with healthy controls. Formerly Churg-Strauss vasculitis, eosinophilic granulomatosis with polyangiitis is rare in pregnancy Oennette, 2013). Hot and associates (2007) described a pregnant woman who responded to IVIG therapy. Corradi and associates (2009) described an afected 35-yearold woman at term whose necrotizing vasculitis involved the heart, and she subsequently underwent cardiac transplantation. Edwards (2015) described one woman who developed postpartum relapses of this vasculitis in each of two pregnancies.
These are acquired and potentially treatable causes of skeletal muscle weakness with a prevalence of 1 in 100,000 persons (Dalakas, 2012). There are three major groups: polymyositis, dermatomyositis, and inclusion-body myositis, which all present with progressive asymmetrical muscle weakness. They have a variable association with connective tissue diseases, malignancy, drugs, systemic autoimmune disease such as Crohn disease, and viral, bacterial, and parasitic infections.
Poymyositis is a subacute inflammatory myopathy that is frequently associated with one of the autoimmune connective tissue disorders. Dermatomyositis manifests as a characteristic rash accompanying or preceding weakness. Laboratory findings include elevated muscle enzyme levels in serum and an abnormal electromyogram. Conirmation is by biopsy, which shows perivascular and perimysial inlammatory infiltrates, vasculitis, and muscle iber degeneration. It usually develops alone but can overlap with systemic sclerosis or mixed connective tissue disease.