Fundus changes in pregnancy induced hypertension

INTRODUCTION: Pregnancy induced hypertension, is the commonest form of life threatening complications of pregnancy. Pregnancy is described as the only physiological state in which most physiological parameters are abnormal. The anatomical, physiological and biochemical adaptations that take place in a woman during the short span of human pregnancy are profound. Compared with normotensive gravidas, patients with elevated blood pressure have significantly greater maternal and fetal mortality and morbidity. The clinical and laboratory characteristics of hypertension associated with pregnancy are difficult to differentiate from those of hypertension independent of pregnancy. AIM OF THE STUDY: To examine the various fundus changes occurring in patients with pregnancy induced hypertension. To determine if fundus examinations might prove of value in determining whether or not the pregnancy should be terminated. MATERIALS AND METHODS: The study was conducted at Govt. Rajaji Hospital Madurai, Maternity section, on 100 patients with pregnancy induced hypertension. THE PATIENTS WERE GROUPED ACCORDING TO: 1. Age 2. Parity 3. Severity of hypertension 4. Grade of fundus changes For all the patients bed side visual activity was tested in the maternity ward as all these patients could not be shifted to the ophthalmology department prior to delivery. External ocular examination was done. The pupils were dilated with tropicamide and detailed fundus examination was done in the maternity ward. The blood pressure was recorded. Routine urine analysis for the presence of protein and sugar was done. Blood biochemical investigations like blood urea, s.creatinine, s.uric acid and total proteins were done. Routine hematological investigations like hemoglobin and platelet count were done. After delivery, the patients were reviewed in the ophthalmology department. A completer ophthalmic examination was carried out. Visual Acuity was tested with Snellens chart. Central visual fields were examined with tangent screen. After papillary dilatation, detailed fundus examination was done. The findings were documented with fundus photography. SUMMARY: 100 Patients with PIH attending the Govt. Rajaji hospital, obstetrics department were studied. The incidence of PIH, at Government Rajaji hospital, Madurai is about 5.1% per year. The fundus of these patients was examined and data analysed for age, parity, severity of hypertension and fundus changes. CONCLUSIONS: Daily Ophthalmoscopic examinations during hospital stay are another important aid to the obstetricians in the management of patients with PIH. The development of hypertensive retinopathy is directly related to the severity of hypertension. It is relatively safe to allow patients with grade I and II hypertensive retinopathy to continue the pregnancy with treatment