A Study of Ocular Fundus Findings in Hypertension during Pregnancy in a Tertiary Care Hospital

Abstract

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 (p<0.01). Prevalence of abnormal fundus findings was 0% among cases with no proteinuria while it was 85.7% in cases with grade 1+ proteinuria. All the cases with grade 2+ or more proteinuria had abnormal fundus findings. A significant association was observed between severity of proteinuria and abnormal fundus findings (p<0.01). No association was observed between laboratory parameters like haemoglobin, uric acid and blood urea nitrogen levels with abnormal fundus findings (p>0.05). 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.