A Clinical Study of Fundus Findings in Toxaemia of Pregnancy
Condition: Hypertension, Pregnancy-Induced
MeSH terms: Toxemia; Hypertension, Pregnancy-Induced; Pre-Eclampsia; Hypertension
Study type: Observational

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): clinical ophthalmoscopy
Intervention type(s): Other
Intervention description(s): To study the role of clinical ophthalmoscopy in PIH in diagnosis, prognosis, differential diagnosis, line of treatment and effect of treatment.
Observational model: Other
Time perspective: Other
Sampling method: Non-Probability Sample
Study population: 
        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 OPD in case of ambulatory patients during the period
        of November 2003 to June 2006 randomly.
      
Keywords: pregnancy induced hypertension; ophthalmoscopy