A study of prevalence and association of fundus changes in pregnancy induced hypertension

Varija T., Vanaja D., Sindhura ., Bellara Raghavenda


Background: The pathological changes of pregnancy induced hypertension appear to be related to vascular endothelial dysfunction and its consequences. The retinal vascular changes generally, but not always, correlate with the severity of systemic hypertension. To find out the prevalence and association of retinal changes in pregnancy induced hypertension.

Methods: A hospital based cross-sectional study was conducted where all antenatal pregnant women who fulfilled the diagnostic criteria of PIH were included in this study. Patients who had pre-existing diabetes or hypertension or renal disease or hazy media which did not permit fundus visualization were excluded from the study.

Socio-demogrpahic and obstetric data was collected and all the patients were subjected to detailed clinical examination followed by fundoscopic examination.

Results: Out of the total 423 patients of PIH examined, the retinal changes (hypertensive retinopathy changes) were noted in 181 (42.7%) patients. The prevalence of retinopathy changes was more among patients with imminent Eclampsia (76.5%) and eclampsia patients (50%). As the severity of the PIH increased the Odds of women developing retinopathy also increased substantially from OR: 17.6; 95% CI: 3.1-136.3 in severe PIH to OR: 253; 95% CI: 47.2-1935 in Imminent eclampsia and this association between the severity of PIH and the development of retinopathy changes was found to be statistically significant.

Conclusions: Fundus examination in cases of PIH is of paramount importance in monitoring and managing cases as it co-relates with the severity of PIH.


Pregnancy induced hypertension, Retinal changes, Fundoscopy

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Subramaniam V. Seasonal variation in the incidence of preeclampsia and eclampsia in tropical climatic conditions. BMC Womens Health. 2007;7:18.

Richard RO. Pregnancy induced hypertension (preeclampsia-ecclampsia) In: Schachat AP, Murphy RB, eds. Retina. 2nd ed. St Louis: Mosby, 1994: 1405-12.

Sibai BM, Cunningham FG. Prevention of preeclampsia and eclampsia. In: Lindheimer MD, Roberts JM, Cunningham FG editors; Chesley’s Hypertensive Disorders of Pregnancy. 3rd ed, Elsevier, New York, 2009:215.

Douglas KA, Redman CWG. Eclampsia in the United Kingdom. Br Med J. 1994;309:1395-1400.

World Health Organization; International collaborative study of hypertensive disorders of pregnancy. Geographic variation in the incidence of hypertension in pregnancy. Am J Obstet Gynecol. 1988;158(1):80-3.

Crowther CA. Eclampsia at Harare maternity hospital. An epidemiological study. S Afr Med. 1985;68(13):927-9.

Bergstrom S, Povey G, Songane F, Ching C. Seasonal incidence of eclampsia and its relationship to metereological data in Mozambique. J Perinat Med. 1992;20(2):153-158.

Dutta DC. Text book of obstetrics. 3rd ed. New Central Book Agency (Pvt) Ltd. Calcutta. 1995:230-6.

ACOG Diagnosis and Management of Preeclampsia and Eclampsia. ACOG Practice Bulletin. 2002;33.

Kanski JJ. 2nd ed. Oxford: Butterworth Heinmann. Clinical ophthalmology-a systematic approach. 1989;329.

Classification of hypertension in pregnancy (National blood pressure education program 2000 and ACOG - 2013.

Noraihan MN, Sharda P, Jammal AB. Report of 50 cases of eclampsia. J Obstet Gynaecol Res. 2005;31(4):302-9.

Nalliah S, Thavarasha AS. Transient blindness in pregnancy induced hypertension. Int J Gynaecol Obstet.1989;29(3):249-51.

Abu Samra K. The eye and visual system in the preeclampsia/eclampsia syndrome: what to expect? Saudi J of Opthal. 2013;27(1):51-3.

Das KA, Jaisal P. Fundus Changes in Pregnancy Induced Hypertension. Int J Med Res Prof. 2016;2(2):47-50.

Tadin I, Bojić L, Mimica M, Karelović D, Dogas Z. Hypertensive retinopathy and preeclampsia. Coll Antropol. 2001;25(Suppl 0):77-81.

Reddy SC, Nalliah S, Rani SA, George PK, Who TS. Fundus changes in pregnancy induced hypertension. Int J Ophthalmol. 2012;5(6):694-7.

Reddy SC. Ocular fundus changes in toxemia of pregnancy. The Antiseptic.1989;86(7):367-72.

Kamath RK, Nayak SR. Preeclampsia/Eclampsia and retinal micro vascular characteristics affecting maternal and foetal outcome: a prospective study amongst south indian pregnant women. IJIRD. 2013;2(11): 444-8.

Dornan KJ, Mallek DR, Wittmann BK. The sequelae of serous retinal detachment in preeclampsia. Obstet Gynaecol. 1982;60(5):657-63.

Rasdi AR, Nik-Ahmad-Zuki NL, Bakiah S, Shatriah I. Hypertensive retinopathy and visual outcome in hypertensive disorders in pregnancy. Med J Malaysia. 2011;66(1):42-7.

Jaffe G, Schatz H. ocular manifestations of preeclampsia. Am J Ophthalmol. 1987;103(3 Pt1):309-15.

Reddy SC. Raghavamma TV. Retinal detachment in preeclampsia- a case report. J Obstet Gynaec of India. 1981;31(3):501-3.

McEvoy M, Runicman J, Edmonds DK, Kerin JF. Bilateral retinal detachment in association with preeclampsia. AustNZ J Obstet Gynaecol. 1981;21(4):246-7.

Jyotsana, Sharma AK, Bhatt S. Reversible blindness in severe preeclampsia and Eclampsia. JK Sci. 2004;6:43-5.

Ryan SJ, Sunness JP. Pregnancy and retinal disease. In: Ryan SJ, eds. Retina. 1994;2:1393-403.

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.