DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20221283

Comparative study of fundus changes in hypertensive and normotensive pregnant females in third trimester at tertiary care centre

Dhruvika Kadam, Jongpongyangla N. Imti, Radha Rastogi, Anuj Sharma, Kanupriya Meena

Abstract


Background: According to ACOG, hypertension in pregnancy can be defined as systolic blood pressure of 140mmhg or higher, diastolic blood pressure of 90mmhg or higher confirmed on atleast two occasions 4-6 hours apart but within a maximum of a week period. The retinal vascular changes have been said to correlate with the severity of hypertension. Many studies have considered the progression of retinal vascular changes as a sign of increasing severity of PIH and have correlated them with fetal mortality. The aim of the study was to comparison of fundus changes among hypertensive and normotensive pregnant female in third trimester.

Methods: 50 hypertensive and 50 normotensive pregnant women were included in the study. All patients fulfilling inclusion and exclusion criteria diagnosed with pre-eclampsia, eclampsia, chronic hypertension were studied for ocular fundus changes and retinal changes were graded according to Keith Wagener classification.

Results: Nearly 3/4th of patients in this study group were primigravida. 64% of patients were in the gestational age less than 36weeks. A significant number of PIH changes were noted in the age group 21-25 however significant number of fundal changes were noted in age group 26-30. 58.33% of study group showed fundal changes of grade III.

Conclusions: The vascular changes in the retina correlate with the severity of the systemic and vascular involvement. Fundoscopy should be offered to all hypertensive pregnant females so that if positive findings are noted, active intervention can be done correlating with other radiological and biochemical findings.


Keywords


Fundoscopy, PIH, Normotensive, Fundal changes

Full Text:

PDF

References


James PR, Nelson-Piercy C. Management of hypertension before, during, and after pregnancy. Heart. 2004;90(12):1499-504.

ACOG Committee on Obstetric Practice. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. American College of Obstetricians and Gynecologists. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2002;77(1):67-75.

Croke LM. Gestational hypertension and preeclampsia: a practice bulletin from ACOG. Am Fam Phy. 2019;100(10):649-50.

Staff AC, Sibai BM, Cunningham FG. Prevention of preeclampsia and eclampsia. In: Chesley's Hypertensive Disorders in Pregnancy. Academic Press.2015;253-67.

Bartsch E, Medcalf KE, Park AL, Ray JG. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ. 2016;353.

Jaskolka D, Retnakaran R, Zinman B, Kramer CK. Fetal sex and maternal risk of pre‐eclampsia/eclampsia: a systematic review and meta‐analysis. Int J Obst Gyn. 2017;124(4):553-60.

Melchiorre K, Sutherland G, Sharma R. Mid-gestational maternal cardiovascular proile in preterm and term pre-eclampsia: a prospective study. BJOG. 2013;120(4):496.

Karki P, Malla KP, Das H, Uprety DK. Association between pregnancy induced hypertensive fundus changes and fetal outcome. Nepal J Ophthalmol. 2010;2(1):26-30.

Handor H, Daoudi R. Images in clinical medicine. Hypertensive retinopathy associated with preeclampsia. N Engl Med. 2014;370(8):752.

Roos N M, Wiegman MJ, Jansonius NM. Visual disturbance in (pre) eclampsia. ObstetGynecolSurv. 2012;67(4):242.

Report of the national high blood pressure education programme working group report on high blood pressure in pregnancy. Am J Obstet Gynecol 2000;183:S1-22.

ACOG Committee on Obstetric Practice. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 2002;77:67-75.3. Dutta DC. Textbook of Obstetrics. In: Konar H, editor. Hypertensive disorders in pregnancy. 6th ed. Ch. 17. Calcutta: New central book agency. 2001;(1):221-42.

Jaffe G, Schatz H. Ocular manifestations in preeclampsia. Am J Ophthalmol 1987;103:309-15.11. Duke E. System of Ophthalmology. In: Sir Stewart, editor. Diseases of Retina. 2nd ed. Vol. X. St Louis: CV Mosby. 1971;136.

Hallum AV. Eye changes in hypertensive toxaemia of pregnancy: A study of three hundred cases. JAMA. 1936;106:1649-51.

Neutra RR. A case control study for estimating the risk of eclampsia in California, Colombia. Am J Obstet Gynecol. 1973;117:894.

Bakhda RN. Clinical study of fundus findings in pregnancy induced hypertension. J Family Med Prim Care. 2016;5:424-9.

Tadin L, Bojic L, Mimica M, Karelovic D, Dogas Z. Hypertensive retinopathy and preeclampsia. Coll Antropol. 2001;25:77-81.

Hayreh SS, Servais GE, Virdi PS. Fundus lesions in malignant hypertension. V. Hypertensive optic neuropathy. Ophth. 1986;93:74-87.

Sadowsky A, Serr DM, Landa J. Retinal changes and fetal prognosis in the toxemias of pregnancy. Obstet Gynecol. 1956;8:426-31.

Davis EA, Dana MR. Pregnancy and the eye. In: Albert & Jakobeik, Azar, Gragoudas. Principles and practice of ophthalmology. 2nd ed. (Philadelphia): W.B. Saunders Company. 2000;4768-69.

Sharma JC, Choudhary B, Maru L, Mathur P. The retina in hypertensive disorders of pregnancy: a study of the prevalence and association with severity of disease in a tertiary referral centre in India. Int J Reprod Contracept Obstet Gynecol. 2020;9:375-82.