Postpartum Retinovascular Findings Among Women Having Preeclampsia With Severe Features Compared to Normal Pregnancy at Kenyatta National Hospital

Abstract

Background Hypertensive disorders in pregnancy (HDP) complicate approximately 10 % of pregnancies and 2-8% of this is attributable to pre-eclampsia-eclampsia. The global burden of HDP remains high, it is estimated to contribute to 14% of direct obstetric causes of maternal deaths comparable to 16% in sub-Saharan Africa. Hypertensive retinopathy complicates about 40-100% of pregnancies with hypertensive disorders and its severity worsens with progression of hypertension. Reactive retinal vessel changes mirror cardiovascular changes in the course of normal pregnancy. Retinal vessel changes are thought to compare with placental vasculature changes and where severe changes are noted, it may indicate placental insufficiency. There are limited studies on the utility of fundoscopy in assessing target organ damage and prognosis in pre-eclampsia in low resource settings. Explorative data on the association between retinovascular changes and umbilical artery Doppler studies can be useful in predicting clinically relevant placental site changes and fetal outcomes. Objectives To compare postpartum maternal retinovascular (RV) findings between pregnancies complicated with preeclampsia with severe features (PES) and normal pregnancies at Kenyatta National Hospital (KNH). Methods A comparative cross sectional study was conducted between May 2017 and March 2018.The study was conducted in KNH, a regional Teaching and Referral hospital. Sixty five women within 72 hours postpartum following pregnancies complicated with PES (n=30) or normal pregnancy (n=35) and without preexisting ocular or medical cormobidities were interviewed on sociodemographic and reproductive health characteristics and clinical parameters obtained from medical records. Visual acuity assessment was done using a portable LogMAR chart and non mydriatic fundus photography used for retinovascular evaluation. RV changes were graded using Keith Wagner grading. Postpartum retinovascular findings and severity grades were analyzed and presented as percentages and compared between the two groups using Chi square or Fisher’s exact test. Odds ratios (OR) of retinovascular changes following pre-eclampsia compared to normal pregnancy was estimated. A p value of <0.05 and 95% confidence interval (CI) that doesn't include the null value were considered significant. Results Overall prevalence of hypertensive retinovascular change was 90.8 %( 83.3% in PES versus 97.1% in normal pregnancies.). We found statistically significantly greater odds, OR 5.05 CI (0.93, 27.6) of severe retinovascular changes after pregnancies complicated with PES (p=0.045). Conclusion There prevalence of maternal retinovascular changes within 72 hours postpartum was high after both pregnancies complicated with PES and normal pregnancy, but not statistically significant difference noted. PES was associated with greater odds of severe postpartum retinovascular changes compared to normal pregnancy. Recommendation The high prevalence of RV changes depicts the need for larger prospective studies to assess disease progression and long term effects. Sensitize caregivers on eye disease in HDP.