Beruflich Dokumente
Kultur Dokumente
75]
Original Article
Pregnancy-induced hypertension (PIH) is a hypertensive Tadin et al., from Croatia had reported 45% of retinal
disorder in pregnancy that occurs in the absence of other changes in their study of 40 patients with PIH.[6] Reddy et al.,
causes of elevated blood pressure (140/90 mmHg, or a rise from Malaysia found 59% of retinal changes in their study of
of 30 mmHg of systolic pressure, or a rise of 15 mmHg of 78 patients.[7] Karki et al., from Nepal have reported 13.7%
diastolic pressure), taken on two occasions after rest, in of fundus changes in their study of 153 subjects with PIH.[8]
304 Medical Journal of Dr. D.Y. Patil University | May-June 2015 | Vol 8 | Issue 3
[Downloaded free from http://www.mjdrdypu.org on Monday, March 5, 2018, IP: 114.125.184.75]
Rasdi et al., from Malaysia found prevalence of retinopathy The results were analyzed using SPSS program. Chi-square
of 21.5%.[9] Ranjan et al., from India found 40% of retinal test was used to determine the association between the
changes in their study of 75 patients.[10] Javadekar et al., from retinal changes and blood pressure, proteinuria, and severity
India observed retinal changes in 42% of patients of PIH.[11] of PIH. A P < 0.05 was taken as significant. Institute Ethical
Committee approval was taken.
Fundoscopic findings in PIH include arteriovenous crossing
changes, hemorrhages, exudates in retina, exudative retinal Results
detachment, and choroidal infarcts.[12]
A total of 150 patients of PIH were examined. The mean
Cortical blindness is one of the important causes of blindness age of patients was 25.1 years (range: 18-45 years). The
in toxemia of pregnancy. One study concluded that cortical gestation period ranged from 27 weeks to 42 weeks; 76
blindness associated with toxemia resulted from petechial (50.67%) were the primi gravida. 92 (61.33%) patients
hemorrhages and focal edema in the occipital cortex.[13] had gestational hypertension, 49 (32.67%) patients had
preeclampsia, and 9 (6%) had eclampsia. 40 patients
This study was undertaken to determine the prevalence of (26.67%) had complaints of headache which was the
retinal changes in PIH and association between the retinal most common symptom, while 19 (12.67%) patients
changes and age, parity, blood pressure, proteinuria, and had complained of blurred vision. Diplopia was seen
severity of the disease. in one patient and scotoma was seen in one patient.
Retinal changes (hypertensive retinopathy) were noted
Materials and Methods in 18 (12%) patients - Grade 1 in 12 (8%) and Grade 2
in 6 (4%) [Table 1]. Hemorrhages or exudates or retinal
This cross-sectional, observational study was conducted over
detachment were not seen in any patient. There was
a period of 17 months (January 2013 to May 2014). All the
statistically significant positive association of retinal
patients who fulfilled the diagnostic criteria of PIH admitted
changes and blood pressure ( P = 0.037), proteinuria
in the obstetric ward, Dr. D. Y. Patil Hospital and Research
(P = 0.0005) and severity of the PIH (P = 0.004) [Table 2].
Centre, Pune were included in this study. Patients who
Age (P = 0.865) and gravida (P = 0.07) were not associated
had preexisting diabetes or hypertension or renal disease
with retinopathy changes.
or hazy media which did not permit fundus visualization
were excluded from the study. After taking history for any
eye symptoms, anterior segment was examined with torch Table 1: Distribution of cases according to different variables
light on the bed itself. Both pupils were dilated with 1% Variable Number of patients (n = 150) (%)
tropicamide eye drops, and fundus examination was done Age (years)
by ophthalmologist with a direct ophthalmoscope in the <19 4 (2.67)
20-29 119 (79.33)
ward. Hypertensive retinopathy changes seen on right
>30 27 (18)
or left or both eyes was taken as positive findings in that Gravida
patient. Age, race, para, gravida, blood pressure, proteinuria G1 76 (50.67)
were noted from the case records. The PIH was graded as G2 41 (27.33)
gestational hypertension, preeclampsia, and eclampsia. All G3 21 (14)
the findings were noted on a data sheet. Consent was taken G4 8 (5.33)
for fundus examination. The retinal changes (hypertensive G5 2 (1.33)
G6 1 (0.67)
retinopathy) were graded according to Keith Wagener
G7 1 (0.67)
classification into:
Duration of pregnancy (weeks)
Grade 1: M ild generalized arterial attenuation, particularly 20-28 1 (0.67)
of small branches; 29-32 6 (4)
Grade 2: More severe Grade 1 + focal arteriolar attenuation; >32 143 (95.33)
Grade 3: Grade 2 + hemorrhages, hard exudates, cotton Severity of PIH
wool spots; Gestational hypertension 92 (61.33)
Preeclampsia 49 (32.67)
Grade 4: G rade 3 = optic disc swelling (papilledema).[14]
Eclampsia 9 (6)
Retinopathy grading
Proteinuria was tested using dipstick method and was graded
Grade 1 12 (66.67)
as + = 30 mg/dL, ++ = 100 mg/dL, +++ = 300 mg/dL and ++++ Grade 2 6 (33.33)
≥2000 mg/dL as provided by manufacturer. PIH: Pregnancy-induced hypertension
Medical Journal of Dr. D.Y. Patil University | May-June 2015 | Vol 8 | Issue 3 305
[Downloaded free from http://www.mjdrdypu.org on Monday, March 5, 2018, IP: 114.125.184.75]
306 Medical Journal of Dr. D.Y. Patil University | May-June 2015 | Vol 8 | Issue 3
[Downloaded free from http://www.mjdrdypu.org on Monday, March 5, 2018, IP: 114.125.184.75]
hypertensive retinopathy. Our result is similar to results 4. Schultz KL, Birnbaum AD, Goldstein DA. Ocular disease in
of Reddy et al.,[7] who found Grade 1 retinal changes in pregnancy. Curr Opin Ophthalmol 2005;16:308-14.
41 (89.13%) and Grade 2 in 5 (10.87%) out of 46 patients 5. Richard RO. Pregnancy induced hypertension (preeclampsia-
ecclampsia). In: Schachat AP, Murphy RB, editors. Retina. 2nd
developing retinopathy changes. ed. St. Louis: Mosby; 1994. p. 1405-12.
6. Tadin I, Bojic L, Mimica M, Karelovic D, Dogas Z. Hypertensive
In our study, none of the patient developed hemorrhages, retinopathy and pre-eclampsia. Coll Antropol 2001;25 Suppl:77-81.
exudates, or retinal detachment. The absence of hemorrhages 7. Reddy SC, Nalliah S, George SR, Who TS. Fundus changes in
and exudates observed in the present study has been pregnancy induced hypertension. Int J Ophthalmol 2012;5:694-7.
supported by Jaffe and Schatz[15] and Reddy et al.[7] This can 8. Karki P, Malla P, Das H, Uprety DK. Association between
be attributed to proper antenatal care and early detection of pregnancy-induced hypertensive fundus changes and fetal
outcomes. Nepal J Ophthalmol 2010;2:26-30.
PIH cases, thereby preventing them to progress to Grade 3
9. Rasdi AR, Nik-Ahmad-Zuky NL, Bakiah S, Shatriah I.
hypertensive retinopathy. Hypertensive retinopathy and visual outcome in hypertensive
disorders in pregnancy. Med J Malaysia 2011;66:42-7.
Of 72 patients who had <160 mmHg systolic and <100 10. Ranjan R, Sinha S, Seth S. Fundus changes and fetal outcomes
mmHg diastolic blood pressure, 4 (5.56%) patients had in pregnancy induced hypertension: An observational study. Int
developed hypertensive retinopathy changes while out J Sci Stud 2014;2:6-9.
of 78 patients who had >160 mmHg systolic and/or >100 11. Javadekar SD, Javadekar DP, Joshi K, Khatiwala R. Fundoscopic
changes in pregnant mother with hypertension complicating
mmHg diastolic blood pressure, 14 (17.95%) patients
pregnancy and various parameters of foetus. Int J Recent Trends
developed hypertensive retinopathy changes. There was Sci Technol 2013;7:110-3.
significant (P = 0.037) association between retinopathy 12. Capoor S, Goble RR, Wheatley T, Casswell AG. White-centered
changes and blood pressure readings in the present study retinal hemorrhages as an early sign of preeclampsia. Am J
which is similar to reported by Tadin et al.,[6] Reddy et al.,[7] Ophthalmol 1995;119:804-6.
and Karki et al.[8] 13. Cunningham FG, Fernandez CO, Hernandez C. Blindness
associated with preeclampsia and eclampsia. Am J Obstet
Gynecol 1995;172:1291-8.
In our study, 58 patients had proteinuria of +1 to +4 on the
14. Kanski JJ. Clinical Ophthalmology — A Systematic Approach.
dipstick. Of 58 patients, 13 (22.41%) patients developed 2nd ed. Oxford: Butterworth Heinmann; 1989. p. 329.
retinopathy compared to 5 (5.43%) patients from 92 who 15. Jaeffe G, Schatz H. Ocular manifestation of preeclampsia. Am
did not have proteinuria. 8 patients who had proteinuria of J Ophthalmol 1987;103:309-15.
4+ on dipstick, 4 (50%) developed hypertensive retinopathy 16. Sunness JS. The pregnant woman’s eye. Surv Ophthalmol
changes. Proteinuria was significantly (P = 0.0005) associated 1988;32:219-38.
with retinopathy which is similar to reported by Reddy 17. Ober RR. Pregnancy induced hypertension. In: Ryan SJ, editor.
Retina. Toronto: Mosby Publications; 1994. p. 441-7.
et al.,[7] Karki et al.,[8] Reddy.[18]
18. Reddy SC. Ocular fundus changes in toxemia of pregnancy.
Antiseptic 1989;86:367-72.
References 19. Ohno Y, Kawai M, Wakahara Y, Kitagawa T, Kakihara M,
Arii Y. Ophthalmic artery velocimetry in normotensive and
1. Sheth BP, Mieler WF. Ocular complications of pregnancy. Curr preeclamptic women with or without photophobia. Obstet
Opin Ophthalmol 2001;12:455-63. Gynecol 1999;94:361-3.
2. Valluri S, Adelberg DA, Curtis RS, Olk RJ. Diagnostic
indocyanine green angiography in preeclampsia. Am J
Ophthalmol 1996;122:672-7. How to cite this article: Shah AP, Lune AA, Magdum RM,
3. Fastenberg DM, Fetkenhour CL, Choromokos E, Shoch DE. Deshpande H, Shah AP, Bhavsar D. Retinal changes in pregnancy-
induced hypertension. Med J DY Patil Univ 2015;8:304-7.
Choroidal vascular changes in toxemia of pregnancy. Am J
Ophthalmol 1980;89:362-8. Source of Support: Nil. Conflict of Interest: None declared.
Medical Journal of Dr. D.Y. Patil University | May-June 2015 | Vol 8 | Issue 3 307