Malignant hypertensive retinopathy as a presenting sign of an occult dead fetus

Abstract

We report one case of malignant hypertensive retinopathy as a presenting sign of fetal death in utero. Ophthalmic examination (including intravenous fluorescein angiography and optical coherence tomography) and obstetric and systemic evaluation were performed, providing a multidisciplinary approach. A 33-year-old overweight woman (body mass index 47 kg/m2) with no systemic or ocular known disease was admitted to our emergency department with a one-week history of bilateral vision loss and no systemic complaints. On examination, best corrected visual acuity was 1/10 in the right eye and 1/10 in the left eye. Anterior segment examination of both eyes was unremarkable. Ophthalmoscopic fundus findings included bilateral optic disc edema, diffuse cotton wool spots, intraretinal exudates, retinal hemorrhages, and multiple serous retinal detachments involving both maculae. Physical examination revealed a blood pressure of 220/110 mmHg. Further systemic workup revealed a previously unknown 35-week pregnancy with a dead fetus. An emergency cesarean section was performed. Pre-eclampsia is a life-threatening disorder for both mother and fetus. This case highlights the need to rule out pre-eclampsia in all women of childbearing age presenting with ocular signs of malignant hypertension, even without external signs of pregnancy.

Association between ophthalmoscopic changes and obstetric outcomes in pre-eclampsia and eclampsia

“…Araújo J et al reported a case of a woman with malignant hypertensive retinopathy who was discovered to bear a dead fetus. 15 Our study found that obstetric complications were common in women having retinal changes compared to those without the changes. Some of these complications might be life threatening, viz: HELLP syndrome and oliguria.…”

Preeclamptic serous retinal detachment without hypertension: A case report

“…In a review of the literature, we identified 43 case reports and case series documenting serous retinal detachment during pregnancy. Our review included 97 women diagnosed with preeclampsia with a median gestational age at presentation of 31.9 weeks (range 20–40 weeks) [ 5 , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] ]. Of cases with blood pressure data reported (90 of 97), only one patient was normotensive.…”

Effect of advanced nursing care on psychological disorder in hypertensive retinopathy of pregnancy

“…[ 12 – 15 ] It not only affects general population with hypertension, but also occurs in pregnancy (also known as hypertensive retinopathy of pregnancy, HTRP), which results in high risk for both mother and fetus. [ 16 – 18 ] In addition, many patients with HTRP often experience psychological disorder (PD), such as depression and anxiety. [ 19 , 20 ] Thus, it is very important to manage this disorder as early as possible.…”