Association between ophthalmoscopic changes and obstetric outcomes in pre-eclampsia and eclampsia
Keywords:Pregnancy, Preeclampsia, Hypertension, Retinopathy, Ophthalmoscopy, Obstetric outcome
Background: Hypertensive disorder is a major cause of maternal and perinatal mortality and morbidity. The widespread endothelial dysfunction associated with preeclampsia can affect the choroid and the retina leading to characteristic ophthalmoscopic changes. So, we tried to find out the association between ophthalmoscopic changes and obstetric outcomes in women with preeclampsia-eclampsia.
Methods: In a comparative, prospective study carried out from July 2011 to July 2015 in Medical College, Kolkata and KPC Medical College, Kolkata we included antenatal women with pre-eclampsia and eclampsia. Based on the ophthalmoscopic findings they were divided into two groups; group A (no ophthalmoscopic abnormalities) and group B (having ophthalmoscopic abnormalities). The results were analyzed by standard statistical methods.
Results: Out of the total 200 women included, 102 women belonged to group A and 98 to group B. Majority of the patients were ophthalmologicaly asymptomatic. Most common fundoscopic abnormality in group B was focal arteriolar narrowing. Women in group B had significantly higher level of blood pressure, proteinuria and thrombocytopenia. The need of multiple drugs, incidence of HELLP syndrome and oliguria, rate of Caesarean section and CCU admission were significantly higher in group B compared to group A. There was significantly higher incidence of perinatal complications in group B, viz: IUGR, low birth weight, low Apgar score and NICU admission.Conclusions: Ophthalmoscopic changes correlate positively with adverse feto-maternal outcomes in preeclampsia. Fundoscopy should be carried out in all preeclamptic mother irrespective of the visual symptoms.
Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009;33(3):130-7.
Working Group Report on High blood Pressure in Pregnancy. National Institute of Health. National Heart, Lung and Blood Institute. National High Blood Pressure Education Program, NIH Publication, 2000.
Roberts JM, Taylor RN, Musci TJ, Rodgers GM, Hubel CA, McLaughlin MK. Preeclampsia: An endothelial cell disorder. Am J Obstet Gynecol. 1989;161:1200-4.
Mihu D, Mihu CM, Tălu S, Costin N, Ciuchină S, Măluţan A. Ocular changes inpreeclampsia. J Oftalmologia. 2008;52(2):16-22.
Abu Samra K. The eye and visual system in the preeclampsia/eclampsia syndrome: What to expect? Saudi J Ophthalmol. 2013;27(1):51-3.
Lam DS, Chan W. Images in clinical medicine. Choroidal ischemia in preeclampsia. N Engl J Med. 2001;344(10):739.
National Institute of Health and Clinical Excellence. NICE Clinical Guideline 107. Hypertension in pregnancy. The management of hypertensive disorders during pregnancy. 2011:26-8.
Pollak VE, Nettles JB. The kidney in toxaemia in pregnancy. A clinical and pathological study based on renal biopsies. Medicine 1960;39:469-526
Uto M, Uemura A. Retinochoroidopathy and systemic state in toxemia of pregnancy. Nihon Ganka Gakkai Zasshi. 1991;95(10):1016-9
Bos AM, van Loon AJ, Ameln JG.Serous retinal detachment in preeclampsia. Ned Tijdschr Geneeskd. 1999;143(48):2430-2.
Bartczak A, Kraśnicki P, Urban R, Laudaiński T, Mariak Z. Bilateral serous retinal detachment in preeclampsia--a case report. Klin Oczna. 2014;116(1):21-3.
Hong J, Liu Y, Liang X, Xiao J. Clinic analysis of retinopathy in gestosis patients. Yan Ke Xue Bao. 2000;16(4):262-3, 275.
Gupta A, Kaliaperumal S, Setia S, Suchi ST, Rao VA.Retinopathy in preeclampsia: association with birth weight and uric acid level. Retina. 2008;28:1104-10.
Kaliaperumal S, Setia S, Gupta A, Rao VA. Fetal birthweight and diastolic blood pressure: association with retinopathy in severe preeclampsia. Eur J Ophthalmol. 2008;18(5):809-12.
Araújo J, Tavares-Ferreira J, Penas S, Figueira L, Paiva FP, Falcão-Reis F. Malignant hypertensive retinopathy as a presenting sign of an occult dead fetus. Clin Ophthalmol. 2015;9:971-5.
Karki P, Malla P, Das H, Uprety DK. Association between pregnancy-induced hypertensive fundus changes and fetal outcomes. Nepal J Ophthalmol. 2010;2(1):26-30.
Garg A, Wapner RJ, Ananth CV, Dale E, Tsang SH, Lee W, et al. Choroidal and retinal thickening in severe preeclampsia. Invest Ophthalmol Vis Sci. 2014;55(9):5723-9.