A Study of Ocular Fundus Findings in Hypertension during Pregnancy in a Tertiary Care Hospital
Keywords:
Conjunctival Vasculopathy, Fundus, Hypertension, Ocular, PregnancyAbstract
Introduction: Hypertension is one of the most common medical disorders during pregnancy, affecting 6-8% of all pregnancies. Around 16-25% of 1st pregnancy &12-15% of subsequent pregnancies8 . Ocular fundus changes are found in 40% to 100% of pregnant women with raised blood pressure, whose severity correlates with pre-eclampsia or eclampsia. In hypertensive disorders in pregnancy, ophthalmic manifestations include conjunctival vasculopathy, hypertensive retinopathy, exudative retinal detachment, hypertensive choroidopathy. The retina is involved due to the basic pathology of vasospasm and increased capillary permeability, the consequences of vascular endothelial dysfunction. Rare complications were reversible cortical blindness, and extra-ocular muscle palsy have been documented. Methodology: The present study was conducted in the Outpatient Department (OPD) of Ophthalmology at Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik , Maharashtra. All the 182 cases included in this study underwent indirect ophthalmoscopy during the study period of 2 years (August 2018 to December 2020). Patients were collected from ANC clinic of department of obstetrics and Gynaecology OPD. Results: Prevalence of abnormal fundus findings was 10.1% in grade I hypertension while it was 100% in cases with grade II and III hypertension. A significant association was observed between severity of hypertension and abnormal fundus findings (p0.05). Conclusion: As these vascular changes in the retina usually correlate with the severity of the systemic hypertension, the eyes can truly be considered a mirror to the otherwise elusive vascular changes occurring elsewhere in the body. It thus stands to reason that observing the retinal changes holds the ability to prognosticate and also determine the severity of the disease. Fundoscopy is an essential investigation that needs to be done in all cases of hypertensive disorders of pregnancy with special emphasis in younger and primigravida women.Downloads
Published
Issue
Section
References
Erem C, Hacihasanoglu A, Kocak M, Deger O, Topbas M. Prevalence of prehypertension and hypertension and associated risk factors among Turkish adults: Trabzon Hypertension Study. J. Public Health. 1 Mar 2009; 31(1):47–58. https://doi.org/10.1093/pubmed/fdn078
Ahmed A, Rahman M, Hasan R, Shima SA, Faruquee MH, Islam T, Haque SE. Hypertension and associated risk factors in some selected rural areas of Bangladesh. Int J Res Med Sci. Jul 2014; 2(3):925. https://doi.org/10.5455/23206012.ijrms20140816
Mishra CP, Kumar S. Risk factors of hypertension in a rural area of Varanasi. Indian Journal of Preventive and Social Medicine. Jan 2011; 42(1):101–11.
Abebe SM, Berhane Y, Worku A, Getachew A. Prevalence and associated factors of hypertension: a crossectional community-based study in Northwest Ethiopia. PloS one.24 Apr 2015; 10(4):e0125210. https://doi.org/10.1371/journal.pone.0125210
Mendis S, Armstrong T, Bettcher D, Branca F, Lauer J, Mace C. World Health Organisation; 2010. Global status report on non-communicable diseases 2010. World Health Organization http://www.who. int/nmh/publications/ncd_ report2010/en. 2014.
Tabrizi JS, Sadeghi-Bazargani H, Farahbakhsh M, Nikniaz L, Nikniaz Z. Prevalence and associated factors of prehypertension and hypertension in Iranian population: the Lifestyle Promotion Project (LPP). PloS one. 26 Oct 2016; 11(10):e0165264. https://doi.org/10.1371/journal. pone.0165264
Iqbal AM, Jamal SF. Essential Hypertension. In Stat Pearls [Internet] 1 Dec 2019. Stat Pearls Publishing.
Nelson-Piercy C. Handbook of obstetric medicine. CRC press; 26 Aug 2020. https://doi.org/10.1201/9780429330766
Mackensen F, Paulus WE, Max R, Ness T. Ocular changes during pregnancy. Deutsches Ärzteblatt International. Aug 2014; 111(33–34):567. https://doi.org/10.3238/arztebl.2014.0567
Dieckmann WJ. Toxemias of pregnancy.
Hughes EC. Obstetric-gynecologic terminology.
Philadelphia: FA Davis. 1972; 422:423.
Davey DA, MacGillivray I. The classification and definition of the hypertensive disorders of pregnancy. Am. J.
Obstet. Gynecol. 1 Apr 1988; 158(4):892–8. https://doi.
org/10.1016/0002-9378(88)90090-7
Bakhda RN. Ocular manifestations of Pregnancy induced Hypertension. The Official Scientific Journal of Delhi Ophthalmological Society. 30 Sep 2015; 26(2):88–92.
https://doi.org/10.7869/djo.144
A System of Ophthalmology. Vol. V. Ophthalmic Optics and Refraction. Br J Ophthalmol. 1970; 54(12):827–827. DukeElder S. System of ophthalmology V. Ophthalmic optics & refraction. 1970. https://doi.org/10.1136/bjo.54.12.827
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. https:// doi.org/10.3126/nepjoph.v2i1.3700
Bharathi RN et al. Fundus changes in pregnancy induced hypertension: a clinical study. JEMDS. 2015; 4(9):1552– 1562. https://doi.org/10.14260/jemds/2015/217
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 ObstetGynecol 2020; 9:375–82. https://doi.org/10.18203/2320-1770.ijrcog20196051
Varija T, Vanaja D, Sindhura, Raghavenda B. A study of prevalence and association of fundus changes in pregnancy induced hypertension. Int J Reprod Contracept Obstet Gynecol 2016; 5:1375–9. https://doi.org/10.18203/23201770.ijrcog20161289
Reddy SC, Nalliah S, George SRA, Who TS. Fundus changes in pregnancy induced hypertension. Int J Ophthalmol. 18 Dec 2012; 5(6): 694–7.
Shah AP, Lune AA, Magdum RM, Deshpande H, Shah AP, Bhavsar D. Retinal changes in pregnancy-induced hypertension. Med J DY Patil Univ 2015; 8:304–7. https://doi.
org/10.4103/0975-2870.157067
Sudha R, Moizuddin MD, Kavya SSK, Sulaiman A. Study of prevalence of fundus changes in pregnancy induced hypertension in a teaching hospital. Indian J Clin Exp Ophthalmol 2019; 5(2):215–8. https://doi.org/10.18231/j.
ijceo.2019.051
Tadin I, Bojić L, Mimica M, Karelović D, ÄogaÅ¡ Z.
Hypertensive retinopathy and pre-eclampsia. Collegium antropologicum. 23 Jul 2001; 25(1):77–81.
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. https:// doi.org/10.3126/nepjoph.v2i1.3700
Kurdoğlu Z, Kurdoğlu M, Ay EG, Yaşar T. Retinal findings in cases of preeclampsia. Perinatal Journal. 2011; 19(2):60– 3. https://doi.org/10.2399/PRN.11.0192003