Fundoscopic changes in preeclampsia and eclampsia and their association with fetal outcome

Abstract

Introduction: Hypertensive disorder is a major cause of maternal and perinatal mortality and morbidity, with preeclampsia and eclampsia being the most common. Preeclampsia is characterized by endothelial dysfunction and vasospasm of vessels, which can be observed by an ocular fundus examination. The fundus usually develops changes such as hypertensive retinopathy, papilledema, exudative retinal detachment, and vitreous and preretinal hemorrhages. Retinopathy is associated with placental insufficiency and intrauterine growth retardation. Therefore, this study has been undertaken to assess the prevalence of retinal changes in preeclampsia and their association with fetal parameters. Objective: To study the fundus changes in preeclampsia. To study the relationship between fundus changes and fetal outcome with respect to various parameters like birth weight, APGAR score, stillbirth, and perinatal death. To study the relationship between fundus changes with respect to proteinuria and serum uric acid. Study Design: Observational study. Methodology: One hundred patients presenting to the department of obstetrics and gynecology diagnosed with preeclampsia at a tertiary care center were included in the study. The patient recruited underwent an ocular examination using Snellen’s chart, a pupillary examination, a slit lamp examination, and a dilated fundus examination. The retinopathy was graded according to Keith and Wagner’s classification. The fetal parameters considered were birth weight, APGAR score, stillbirth, and neonatal death. Results: Patients ages ranged from 25 to 30 years old, with an average of 23.28 ± 3.37. Average systolic and diastolic blood pressures were 156.9 ± 17.961 and 104.88 ± 13.58, respectively. All patients had normal anterior segments. Visual acuity was6/6 in most of the patients. Fundus changes were noted in 48% of patients. Based on retinopathy classification, we found 66.7% patients with Grade 1 and 27.1% patients with Grade 2 hypertensive retinopathy. Only 6.3% of patients presented with Grade 3 hypertensive retinopathy. There was a significant association between retinopathy and proteinuria (P = 0.003), serum uric acid (P = 0.002), and the fetal birth weight (P = 0.001). Conclusion: Our findings suggest that progressive fundal changes in preeclampsia indicate worsening of the pathophysiological status of pregnancy-induced hypertension (PIH) and help in management. The degree of hypertensive retinopathy in women with preeclampsia is a valid and reliable prognostic factor that serves as an indirect marker of the severity of PIH and fetal outcome. Fundus examination is a simple, noninvasive, and cost-effective procedure that could be the initial finding in an asymptomatic patient who may require immediate management, which may help in saving the lives of both the mother and the baby. Fundus evaluation is essential for all patients with PIH.

Keywords

• fetal outcome
• preeclampsia
• pregnancy