A Clinical Study of Fundus Findings in Toxaemia of Pregnancy
A Clinical Study of Fundus Findings in Toxaemia of Pregnancy
Toxemia of pregnancy is a recognized entity for over 2000 years with its known complications
 and fatality. Nowadays, a most accepted terminology for the following defined syndrome is
 "hypertensive disorders in pregnancy" given by American College of Obstetrics and Gynecology.
 It is an important cause of maternal and fetal morbidity and mortality. Pregnancy induced
 hypertension (PIH) was classified as gestational hypertension, preeclampsia, severe
 preeclampsia and eclampsia. PIH is a hypertensive disorder in pregnancy that occurs after 20
 weeks of pregnancy in the absence of other causes of elevated blood pressure (BP) (BP >140/90
 mmHg measured two times with at least of 4 hour interval) in combination with generalized
 edema and/or proteinuria (>300 mg per 24 hrs). When there is significant proteinuria it is
 termed as preeclampsia; seizure or coma as a consequence of PIH is termed as eclampsia.
 Preeclampsia was classified into mild and severe preeclampsia.

 Mild eclampsia-BP >140/90 mmHg, proteinuria+, and/or mild edema of legs, Severe
 preeclampsia-BP >160/110 mmHg,proteinuria++ or ++++, headache, cerebral or visual
 disturbances, epigastric pain, impaired liver function tests and increase in serum
 creatinine.

 Proteinuria was tested using dipstick method as +=0.3 gm/L, ++=1 gm/L, and +++=3 gm/L.

 The pathological changes of this disease appear to be related to vascular endothelial
 dysfunction and its consequences (generalized vasospasm and capillary leak). Ocular
 involvement is common in PIH.Common symptoms are blurring of vision, photopsia, scotomas and
 diplopia. Visual symptoms may be the precursor of seizures.Progression of retinal changes
 correlates with progression of PIH and also with the fetal mortality due to similar vascular
 ischemic changes in placenta.Vasospastic manifestations are reversible and the retinal
 vessels rapidly return to normal after delivery. Ophthalmoscope should be rated next to the
 sphygmomanometer as an instrument of diagnostic importance in cases of PIH. Ophthalmoscopy
 does not only helps in diagnosing the disease but repeated observations assist in assessing
 the severity, progress of disease, response to treatment if any and ultimate outcome or
 prognosis.
An observational study in which the patients for the study are selected from antenatal
 clinic, antenatal ward and "preeclampsia and eclampsia room" in Department of Obstetrics and
 Gynecology and general Ophthalmic Out Patient Department(OPD) in case of ambulatory patients
 during the period of November 2003 to June 2006 randomly.In every case, detail obstetric
 history including a detail antenatal history was taken. General examination and relevant
 pathological investigations like routine blood count, HIV, HBsAg, renal function tests, TORCH
 complex etc., were carried out. In every case, pupil was dilated with homatropine (2%) eye
 drops. Then detailed ophthalmic examination was carried out with special emphasis on direct
 ophthalmoscopy apart from visual acuity of both eyes and anterior segment examination. Fundus
 findings were noted in detail, changes in the color of the disc, disc margin, physiological
 cup, changes in retinal blood vessels especially caliber of vessels, arterio-venous (AV)
 ratio,changes in vessel wall, blood column, appearance of vascular light reflex, changes at
 AV crossings, changes in macular area and changes in background, overall appearance, presence
 of hemorrhages, exudates or any pathology were recorded.

 Fundus changes were graded as per modified Keith, Wagner and Barker classification.Assessment
 of prognosis as regards to vision and life (mortality) was made.
Inclusion Criteria:

 -  Cases of Pregnancy Induced Hypertension.

 Exclusion Criteria:

 -  Cases complicated by malignancy, renal, liver or other secondary manifestations.