Book of Medical Disorders in Pregnancy - Tintash

increase in blood pressure above the
coarctation. The blood pressure in the
upper half of the body is raised, while
the pressure in the femoral vessels is
diminished. When pregnancy is complicated
with this lesion, it can be
associated with a very high perinatal
mortality. Maternal mortality is not
significantly affected. Diagnosis can be
made by noting the pulse in radial and
femoral arteries at the same time. The
pulse wave in the femoral artery is
considerably varied when compared with
the radial. The pressure recorded in
femoral artery is considerably less than
the brachial. The blood vessels in the
interscapular region are easily visible,
they are collateral vessels. A bruit may
be heard over the collateral vessels.
Similarly a murmur can be heard in the
scapular region.
Chest x-ray can confirm the diagnosis.
The shadow of dou-ble aortic knuckle
seen on X ray is due to dilated subclavian
artery and descending aorta. If
aortography is available, it can also be
helpful. Coarctation of the aorta can be
corrected surgically during pregnancy.
Only an experienced vascular surgeon
can help in dealing with this situation
and lowering the perinatal mortality
considerably.
Renal artery stenosis:
This is not a common condition. When
all other causes of hypertension have
been excluded, renal artery stenosis
should be suspected; especially if the
patient has wide spread arterial disease
and a bruit is heard on the abdomen or
loin. Causes of this condition include
atherosclerosis, dissecting aneurysm of
the aorta or fibro muscular hyperplasia.
Pressure from neighboring tumors or
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cysts can also produce renal artery
stenosis. Similarly thrombosis or embolism
of the renal artery may be responseble.
Diagnosis can be made by
intravenous pyelography. The affected
kidney will be smaller. The contrast
medium in the affected kidney is very
dense because its excretion is delayed.
For definite dia-gnosis, aortography or
renal arteriography, both of which are
contraindicated in pregnancy, can be
very helpful.
Fig4.4: Shows stria marks on the
abdominal wall.
Cushing's syndrome - It results from
excess of glucocorticoids produced by
the adrenal tumor. This could also be
due to pituitary dysfunction where excessive
ACTH is produced. Diagnosis
can be made from detection of characteristic
features.
The patient presents with central obesity,
round moon face, buffalo neck, hirsutism,
and acne. Purplish strias are present
on the abdomen. The masculinizing
features are due to excessive androgens.
Laboratory investigations such as increased
levels of cortisol and 17 hydroxy
steroids, along with abnormal glucose
tolerance test, confirm the diagnosis.
These patients often have amenorrhea
and infertility, therefore pregnancy