VP31.22: Multidisciplinary team management in a pregnancy with Takayasu arteritis complicated by COVID‐19 infection

Takayasu arteritis (TAK) is a rare systemic, inflammatory large‐vessel vasculitis, most commonly affecting women of childbearing age. Its incidence in pregnancy is 2.6 cases/million/year. Obstetrical complications are increased by 13 fold. We present the management of a pregnant female with TAK with COVID‐19 infection, with threatened preterm labour and superimposed pre‐eclampsia. A 20‐year‐old female, G3A2 at 33+2 weeks of gestation presented with threatened preterm labour. She was diagnosed with Takayasu Arteritis in first trimester during work up for chronic hypertension. Patient was on labetalol 300 mg three times a day, aspirin 150 mg and prednisolone 7.5 mg OD from first trimester. On admission, patient had raised blood pressure records of 160/110 mmHg in left limb and 160/108 in right limb. Investigations were reviewed. MRI showed right common carotid and right renal arterial stenosis. Patient also turned out to be COVID positive. Multidisciplinary management with involvement of cardiologist, endocrinologist, anesthetist was done within two hours of admission despite the patient being COVID positive. Intravenous labetalol 20 mg and tocolysis were given and dexamethasone started for fetal lung maturity. Contraction ceased after one hour, BP was controlled, maternal and fetal monitoring and she was shifted to designated COVID facility. A biophysical profile done on 3rd day of admission was found to be 6/10 and an emergency LSCS was planned. Patient delivered a male baby weighing 1.6 kg. Injection hydrocortisone was given to prevent Addisonian crises. Enalapril 2.5 mg BD and Amlodipine 10 mg OD were added on tab labetolol 300 mg TDS post‐delivery for control of blood pressure. Both mother and baby were discharged in stable condition on day 17 of delivery. To conclude, multidisciplinary approach and management can ensure a successful maternal and fetal outcome in pregnant women with comorbidities and COVID infection.