Clinical study of fundus findings in pregnancy induced hypertension

A algorithm for prediction of exudative retinal detachment risk of patients with pregnancy-induced hypertension

AIM

To investigate the risk of exudative retinal detachment (ERD) morbidity in patients with pregnancy-induced hypertension (PIH) by using the logistic regression combined with the receiver operating characteristic (ROC) curve.

METHODS

A total of 46 patients with ERD and 142 patients with non-ERD were diagnosed as PIH from January 2017 to February 2020. A retrospective comparison of the clinical manifestations and laboratory tests were conducted. The risk of ERD morbidity with PIH was predicted by using logistic regression combined with an ROC curve model.

RESULTS

There was no significant difference in age and body mass index between the two groups before pregnancy (P>0.05). However, significant differences were found in gestational weeks, duration of hypertension, maximum and minimum systolic and diastolic blood pressure (BP), and plasma total protein (PTP) concentration between the two groups (P<0.05). Binary logistic regression analysis showed that the maximum systolic BP (OR=1.050, 95%CI: 1.016-1.085) and PTP concentration (OR=0.764, 95%CI: 0.702-0.832) were independent prediction risks of ERD in PIH. The sensitivities of maximum systolic BP, PTP concentration and combined diagnosis were 0.717, 0.870, and 0.870, respectively; the specificities were 0.617, 0.837, and 0.908, respectively; the area under the curve (AUC) was 0.707 (95%CI: 0.622-0.792), 0.917 (95%CI: 0.868-0.967), and 0.933 (95%CI: 0.890-0.975), respectively; the AUC of combined diagnosis was higher than that of single diagnosis (P<0.01).

CONCLUSION

Logistic regression and ROC curve model combined with maximum systolic BP and PTP can improve the early identification of high-risk PIH patients in the hospital.

Hypertensive Disorders of Pregnancy

The 4 categories of hypertensive disorders of pregnancy are chronic hypertension, gestational hypertension, preeclampsia-eclampsia, and chronic hypertension with superimposed preeclampsia. These disorders are among the leading causes of maternal and fetal morbidity and mortality. Proper diagnosis in the emergency department is crucial in order to initiate appropriate treatment to reduce the potential harm to the mother and the fetus. Prompt management should be undertaken when the blood pressure is greater than 160/110 mm Hg or there are other severe features such as acute kidney injury, elevated liver function tests, severe abdominal pain, pulmonary edema, and central nervous system disturbances.

Ocular posterior pole pathological modifications related to complicated pregnancy. A review

Ocular posterior pole modification are a pathological manifestation in complicated pregnancies, especially when pregnancy induced hypertension is present (PIH), as well as in preeclampsia (PE) or eclampsia. Nonetheless, as the pregnancy evolves, the possibility for an aggravated evolution with HELLP syndrome, disseminated intravascular coagulation, and idiopathic thrombocytopenic purpura may have an ocular manifestation that, mainly, implies a loss of visual field or acuity, that, left unattended, may constitute a permanent impairment. Pregestational conditions like pituitary adenoma or genetic pedigree for complement factor H gene (1q31.1) single nucleotide mutations could lead to central serous chorioretinopathy or retinal detachment with severe, ischemic, central cilioretinal artery or vein occlusion and optic nerve atrophy. Furthermore, although subtle in many cases, any new visual symptoms during pregnancy should constitute an alarming factor for obstetrical reevaluation and ophthalmological approach in order to preserve the mother's quality of life.