الفهرس 
Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Pregnancy Induced Hypertension is a challenging stigma in the field of obstetrics and one of major contributors to maternal and perinatal mortality. Pregnancy is associated with a group of physiological and pathological changes. Pregnancy Induced Hypertension [PIH] is a hypertensive disorder in pregnancy that occurs after 20 weeks of pregnancy in the absence of other causes of elevated blood pressure i.e., ≥140/90 mm Hg measured 2 times with at least of 6-hour interval.
Pregnancy Induced Hypertension is a multisystem disorder which includes cardiovascular, haematological, hepatic, renal, neurological abnormalities and ocular manifestations. Severe toxemia is the main cause for visual system involvement. The retinal vascular changes majority of times but not always correlate with systemic hypertension. The constriction of vessels may take days to develop and may last for weeks to months.
Ocular involvement is common in Pregnancy Induced Hypertension occurring in as many as 30% of patients. Common symptoms are blurring of vision, photopsia, scotomas and diplopia. Visual symptoms may be the precursor of seizures. The retina is a unique site where the vasculature in the human body is visualized directly with the help of ophthalmoscope. The eye serves as a window through which the vessels of the body can be studied. Thus, a change in the retinal arterioles may indicate a similar state of the placenta; hence, it gives a reasonable idea of the state of placental circulation and fetal wellbeing. Fetal and maternal complication can be avoided if PIH is detected early. The pathological changes of this disease appear to be related to vascular endothelial dysfunction and its consequences [generalized vasospasm and capillary leak]. Vasospastic manifestations are reversible, and the retinal vessels rapidly return to normal after delivery. The changes related to retinal vascular which were observed have also been said to be correlated with the severity of hypertension. As per the literature searched related to PIH studies, the wellbeing related to fetus will be depends on its placental circulation. It was observed that the vascular changes in placenta, indicated with the presence of changes may occurs in retinal arterioles/hemorrhages. So, the ocular observation to the mother’s fundus may also results in the interpretation/report, which will be similar micro-circulation changes of placenta and it‟s indirectly to the fetus wellbeing. So, the fundus observation of during the pregnancy induced hypertension, will be the important clinical tool to predict/interpret the adverse fetal outcomes. The aim of this study was to study the association between fundus changes and pregnancy induced hypertension and its fetal outcomes.
This was Prospective observational follow up study, involving 121 antenatal pregnant women with high arterial blood pressure systolic blood pressure ≥140mm hg and diastolic blood pressure of 100 mm Hg, The duration of the study ranged from Dec2019 to Jun2021.
The main results of our study revealed that:
● Patients‟ age ranged 18 - 35 years with mean BMI 27.92 kg/m2. Mean GA 37.21 weeks.
● Regarding gravida status, most of patients were primigravida by 74%. Meanwhile, most of the patients were delivered Vaginally. ● Most of enrolled patients by 75.2% with systolic blood pressure up to 159 mmHg and diastolic blood pressure up to 109 mmHg. ● Most of enrolled patients were 1+ proteinuria by 34.7% and the least was 2+ proteinuria by 14.8%
● Most of our patients were pre-eclampsia with mild features by 49.5% and the least was pre-eclampsia with sever features by 24.8%.
● Most of our patients [62%] had no ophthalmoscopic changes while 29.8% of the patients were grade I retinopathy and 7.4% of the patients were grade II retinopathy and 0.8 grades III. ● There was a significant difference between the grades of ocular fundus changes regarding age, SBP, DBP, proteinuria, severity of PIH and laboratory investigation of PLT, Urea.
● There was a significant difference between the severity of PIH regarding laboratory investigation. ● There was no significant difference between grades of ocular fundus changes regarding mode of delivery.
● In current study fetal outcomes included: mean GA was 37.21 ± 2.78 weeks, mean birth weight was 2.69 ±1.06 kg, and mean Apgar at 1 min was 6.5 ±1.27 and at 5 min was 8.5 ± 1.09 and 13 cases of NICU admission.
● There was significant difference between the grades of ocular fundus changes with maternal morbidity regarding placental abruption, eclampsia and impaired coagulation and no case of mortality. ● There was a significant difference between the grades of ocular fundus changes with fetal outcomes regarding gestational age and Apgar score at 1 min and NICU admission.