The prevalence, patterns and factors associated with ocular manifestations of pre-eclampsia/eclampsia at Mulago National Referral Hospital

Abstract

Introduction Up to 25% of patients with severe pre-eclampsia and 50% of patients with eclampsia have visual symptoms of clinical significance, while 1-3% of affected patients remain with irreversible blindness due to involvement of the visual cortex(Mushumbusi, Mafwiri et al. 2016) The ocular changes in preeclampsia usually occur from 20+ weeks of gestation and may progress gradually or rapidly until the symptoms begin to be noted. Ocular changes can be screened among pre-eclamptic mothers using slit lamp examinations of a fully dilated pupil. However in Mulago National Referral hospital-Uganda, pre-eclampsia and eclampsia mothers are hardly ever screened for ocular changes. Objectives To determine the magnitude, pattern and factors associated with ocular manifestations of preeclampsia/eclampsia patients attending Mulago National Referral hospital Methods This was a cross sectional study involving 450 pre-eclampsia mothers at kawempe referral hospital from September to December 2017.The mothers were recruited consecutively. Pretested questionnaires were used to record relevant history and ocular examination findings. Results were analyzed using the descriptive, bivariate and multivariate analysis. Data was cleaned and entered into a computer in EPI-DATA (epidemiology data) and exported to STATA version 14.0, to aid analysis. Results A total of 450 pregnant women participated in the study. The age range was 18-42 years with a median of 27 years. The prevalence of ocular manifestations was 16.5 % CI (13.3% – 20.2%). The patterns of ocular manifestations were optic disc edema 19 mothers (26.7%), retinal hemorrhages 17(22.9%), cotton wool spots16 (21.6%), optic disc pallor 4(5%), aneurysms 3(4%) and arteriolar narrowing 3(4%) The factors associated with ocular manifestation of preeclampsia /eclampsia were education (p-value=0.042), sub-urban residence (p-value=0.045), severe preeclampsia and eclampsia (p-values=0.008 and 0.00), abnormal liver function test (p-value=0.002) and abnormal visual acuity (p-value=0.000) Conclusion The prevalence of ocular manifestations of pre-eclampsia and eclampsia among women in Mulago National Referral hospital is high. For every 5 mothers with preeclampsia/ eclampsia, one (1) may have ocular manifestations. The commonest ocular presentations of eclampsia and pre-eclampsia are retinal haemorrhages, cotton wool spots, retinal oedema and optic disc oedema. Recommendation There is need for ophthalmic assessment among women during the prenatal and post-natal period to ensure early possible diagnosis and management of the ocular manifestations of pre-eclampsia. Ophthalmic assessment among pregnant women should be included in the antenatal package to ensure early diagnosis and management of the ocular manifestations of preeclampsia/ eclampsia. The mothers with severe ocular manifestations need to be followed up by an ophthalmologist to offer appropriate treatment.