A clinical study of fundus changes in pregnancy induced hypertension in tertiary health care Centre in Sevagram, Wardha, India

Abstract

Introduction: The most common abnormalities seen in pregnancy induced hypertension (PIH) are fundus spasm, focal/generalized narrowing of retinal arterioles, haemorrhages, exudates, peripapillary or focal retinal oedema, serous retinal detachment, bilateral retinal detachment, exudative retinal detachment and severe macular oedema. There is a paucity of data available in the published literature on the prevalence of retinal changes in PIH from India. Aim: The purpose of the present study was to find the prevalence of retinal changes in PIH and the association between the retinal changes and severity of PIH. Materials and Methods: 350 women with gestational ages between 20 and 40 weeks admitted in the maternity ward in the Department of Obstetrics and Gynaecology of Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha between November 2017 and November 2019 with features of PIH both asymptomatic and symptomatic were included in this cross-sectional study. Age, parity, gestational period, blood pressure and proteinuria of the patients were documented. Fundus examination was done to find the retinal changes (hypertensive retinopathy) according to Keith Wagener classification. Comparison of the distribution of categorical variables was done using Fisher’s exact test. Results: Of 350 patients, 218 (62.3%), 92 (26.3%), 34 (9.7%), 5 (1.4%) and 1 (0.3%) had normal, Grade I, Grade II, Grade III and Grade IV fundus changes respectively. The prevalence of Grade III/IV hypertensive retinopathy was significantly higher in eclampsia 4/34 (11.8%) as compared to gestational hypertension 0/210 (0.0%) and preeclampsia 2/106 (1.9%) (p-value< 0. 0001). The prevalence of Grade III/IV hypertensive retinopathy was significantly higher in patients who had systolic blood pressure > 180 mm of Hg 1/4 (25.0%), diastolic blood pressure > 110 mm of Hg 1/9 (11.1%). Conclusion: The occurrence of hypertensive retinopathy is associated with pregnancy-induced hypertension. Fundus examination is very important in patients having PIH.