Clinical Study of Retinal Changes in Pregnancy Induced Hypertension

Abstract

Background:Pregnancy induced hypertension, is the commonest form of life-threatening complications of pregnancy. Pregnancy is described as the only physiological state in which most physiological parameters are abnormal. The anatomical, physiological and biochemical adaptations that take place in a woman during the short span of human pregnancy are profound. Compared with normotensive gravidas, patients with elevated blood pressure have significantly greater maternal and foetal mortality and morbidity. The clinical and laboratory characteristics of hypertension associated with pregnancy are difficult to differentiate from those of hypertension independent of pregnancy. Objective: The objective of this study was to study the prevalence and risk factors of ocular fundus changes among pregnant women with PIH. Materials and Methods: A hospital‐based, cross‐sectional study was carried out among 130 pregnantwomen with PIH. History of symptoms related to the eyes, age, and gravida was recorded. Torchlight was used to examine the anterior segment. One percentage of tropicamide was used to dilate pupils. Direct ophthalmoscope was used to examine the fundus. Blood pressure was measured as per the standard guidelines. Urine sample was taken to look for the presence of proteins in urine. Results: The majority belonged to 18 to 35years (50%) and the majority (54.6%) had gestational age >37 weeks. The majority (75.38%) had gestational hypertension. The prevalence of retinopathy among pregnant women with PIH was 13.7% Grade I retinopathy was most commonly seen in 7.7% of cases followed by Grade II retinopathy in 2.7% of the cases, grade 3 in 1.4% and grade 4 in 0.6%. one patient had exudative retinal detachment. Age was not found to be associated with retinopathy among pregnant women with PIH. The prevalence of retinopathy among women with preeclampsia was 31.7% and in eclampsia was 40 %, compared to only 7.07% in women with gestational hypertension and this difference was statistically significant (P < 0.05). The prevalence of retinopathy among women with blood pressure >150/100 mmHg was 45.4% compared to only 2.6% in women with bloodpressure<150/100 mmHg and this difference was statistically significant (P < 0.05). The prevalence of retinopathy among women with severe proteinuria (+++) was 66.6% compared to 44.5% in women with moderate proteinuria (++), 22.7% among women with mild proteinuria (+) and only 5.5% in women without proteinuria. These differences were statistically significant (P < 0.05) Conclusion: The prevalence of retinopathy among pregnant women with PIH was high. High blood pressure and severe proteinuria and preeclampsia were significantly associated with retinopathy.