A Study of Fundus Changes in Patients with Pregnancy Induced Hypertension Attending Tertiary Care Centre
A Study of Fundus Changes in Patients with Pregnancy Induced Hypertension Attending Tertiary Care Centre
DOI:
https://doi.org/10.70284/njirm.v9i1.1840Keywords:
Fundus changes, Pregnancy induced hypertension, ProteinuriaAbstract
Introduction: Retinal changes are a frequent observation in pregnancy-induced hypertension. Early detection and monitoring of these changes can help to determine the further course of pregnancy. The study is intended to determine the prevalence of retinal changes in pregnancy-induced hypertension (PIH) and the association of these changes with the blood pressure, proteinuria, and disease severity. Methods: All patients admitted with the diagnosis of PIH were observed in this study. Age, gravida, gestational period, blood pressure, and proteinuria were noted. A proper history of any ophthalmological symptoms and Fundoscopic examination was done after dilation of the pupils with a direct ophthalmoscope in, the ward itself. All findings were noted and then analyzed. Results: A total of 75 patients of PIH were examined. The mean age of patients was 24.88 years (range 18-39 years). The gestation period ranged from 27 weeks to 42 weeks; 40 (53.33%) were primigravida. 35(46.66%) were multigravida. 44 (58.66%) patients had mild preeclampsia, 26 (34.66%) had severe preeclampsia and 5 (6.66%) had eclampsia. Retinal changes (hypertensive retinopathy) were noted in 25 (33.33%) patients --- grade I in 19 (25.33%) and grade II in 4 (5.33%). Haemorrhages or exudates were seen in 1 (1.33%) patient and retinal detachment was seen in 1(1.33%) patient. There was a statistically significant positive association between retinal changes and blood pressure (p<0.0001), proteinuria (p=0.0000036) and severity of the PIH (p=0.0001). Conclusion: Ophthalmic fundus examination is an important procedure to be performed in all pregnant hypertensive women. It helps to determine the further course of pregnancy. In our study, Retinal changes were seen with PIH and they were significantly associated with blood pressure, proteinuria, and severity of the disease.
References
2. Valluri S, Adelberg DA, Curtis RS, Olk RJ.Diagnostic indocyanine green angiography in preeclampsia.Am J Ophthalmol 1996 Nov;122:672-77.
3. Chap 18. Hypertensive disorders of pregnancy. In: Mudaliar & Menon,editor. Clinical Obstetrics. 9 th edition. Chennai: Orient Longmann; 1999 p.133.
4. Jaeffe G, Schatz H. Ocular manifestation of preeclampsia. Am J Ophthalmol 1987 Mar; 103(3):309-15.
5. Schultz KL,Birnbaum AD,Goldstein DA. Ocular diseases in pregnancy. Curr Opin Ophthalmol 2005 Oct; 16(5):308-14.
6. Wagener HP: Arterioles of the retina in toxemia of pregnancy JAMA 101:1380-1384 1993.
7. Beck RW,Gamel JW, WillcourtRJ, Bermang Acute Ischemic optic neuropathy in severe preeclampsia Am.J.Ophthalmol. 90:342-346 1980.Ober R R: Pregnancy-induced hypertension (Preeclampsia-eclampsia) in Ryan SJ (ed): Retina.St Louis, C.V. Mosby, 1994 p 1405-1412.
8. Mussey RD, Mundell BJ: Retinal examinations: A guide in the management of toxic hypertensive syndrome of pregnancy Am.J.Obstet. Gynecol. 37:30-36 1939.
9. Hallum A V eye changes in hypertensive toxemia of pregnancy, A study of 300 cases JAMA 106 1649-1657 1936.
10. Ober R R: pregnancy-induced hypertension in Ryan SJ (ej): Retina St Louis, C.V.Mosby, 1994p 1405-1412.
11. Olive M, Uchenik D, Bilateral retinal detachment in eclampsia without hypertensive retinopathy. Am J Ophthalmol. 90: 792-796 1980.
12. Beeson JH, DudaEE Computed Axial tomography scan demonstration of cerebral edema in eclampsia preceded by blindness Obst. Gynecol: 60 529-532 1982.
13. Rasdi AR, Nik-Ahmad-Zuki NL, Bakiah S, Shatriah I: hypertensive retinopathy and visual outcome in hypertensive disorder in pregnancy. 2011; 66(1) : 42-47.
14. Tadin I, Bojic L, Mimica M, Karelovic D, Dogas Z. hypertensive retinopathy, and preeclampsia. Coll Anthropol. 2001; 25 (Suppl 0); 77-81.
15. D.C Dutta –Textbook of Obstetrics Edition 7p 221.
16. Reddy SC. Ocular fundus changes in toxemia of pregnancy. The Antiseptic. 1989;86(7):367-372.