Pregnancy-induced hypertension syndrome
Introduction
Introduction to fundus lesions in pregnancy induced hypertension Pregnancy-induced hypertension (referred to as pregnancy-induced hypertension), formerly known as pregnancy poisoning. It usually occurs 9 months after pregnancy, and it can happen earlier if the pregnant woman has high blood pressure. All patients had elevated blood pressure and its accompanying symptoms such as edema, proteinuria and fundus changes. This is a serious disease that threatens the safety of maternal and fetal life. Timely diagnosis and treatment are of great significance for protecting maternal vision and mother and child life safety. The fundus lesion of pregnancy-induced hypertension syndrome refers to the syndrome of hypertension, edema, proteinuria and fundus lesions after 20 weeks of pregnancy. basic knowledge The proportion of illness: 0.05% (more common in older women) Susceptible population: pregnant women Mode of infection: non-infectious Complications: retinal detachment
Cause
Causes of fundus lesions in pregnancy induced hypertension
(1) Causes of the disease
Associated with an acute increase in blood pressure.
(two) pathogenesis
The retinal circulation is not dominated by sympathetic nerves, mainly self-regulating. When the blood pressure rises acutely, the normal retina automatically regulates, showing vasoconstriction, increased tension, retinal artery limitation or general stenosis is a functional contraction, when the whole body condition improves After the blood pressure is lowered, it can disappear without permanent vascular injury. The functional contraction of the retinal artery lasts for about 1 month, and it can be completely recovered. However, if it does not relieve for a long time, it will gradually develop into retinal arteriosclerosis, and the hypertension will last for a long time. Regulation failure, blood-retinal barrier destruction, retinal ischemia, hypoxia, hemorrhage, edema and cotton plaque, choroidal capillaries are mainly sympathetically innervated, choroidal artery contraction is a response to systemic hypertension, hypertensive choroidal lesions The mechanism of vascular occlusion is unclear, and may be related to sympathetic disorders, fibrin platelet coagulation, and finally embolus formation. Choroidal capillaries may have multiple obstructions, with retinal pigment epithelium and outer retinal ischemia, and late pigmentation changes.
Hypertension optic neuropathology is still inconclusive. The blood supply of the optic disc includes both the central retinal artery branch and the short ciliary artery. The main part is the short ciliary artery. In addition, the front of the optic disc is affected by intraocular pressure, followed by the cobweb. The subarachnoid space is affected by intracranial pressure. The optic disc edema of malignant hypertension is not only the manifestation of increased intracranial pressure or hypertensive encephalopathy, but also an independent disease, namely hypertensive optic neuropathy, which is a type of anterior part. Ischemic optic neuropathy, when hypertension vasoconstriction or obstruction, releases an angiogenesis inhibitor, such as angiotensin II, which may be a cause of ischemia, axonal ischemia leading to axial flow block and optic disc Axonal swelling.
Prevention
Prevention of fundus lesions in pregnancy induced hypertension
For maternal and fetal life safety and to protect maternal vision, diagnosis should be made as soon as possible, and pregnancy should be terminated as soon as necessary.
Complication
Complications of fundus lesions in pregnancy induced hypertension Complications
Cotton eye spots and serous retinal detachment.
Symptom
Symptoms of fundus lesions in pregnancy-induced hypertension syndrome Common symptoms Hypertension Cardiovascular sclerosis Fundus changes Pre-eclampsia Pregnancy-induced hypertension Heart palpitations Dizziness convulsions Coma
All patients have increased blood pressure, early symptoms called preeclampsia, with the symptoms worsened to develop eclampsia, patients may have headache, dizziness, nausea, vomiting, systemic edema, especially eyelids, lower extremity edema, proteinuria, palpitations, shortness of breath Even convulsions, coma, unconsciousness and other symptoms, the higher the blood pressure, the higher the incidence of fundus changes. When the blood pressure is lower than 150/100mmHg, the fundus change rate is 16.6%; when 150/100175/125mmHg, it is 36.6. %, the blood pressure exceeds 175/125mmHg, the incidence rate is 46.8%. Another report indicates that when the systolic blood pressure is greater than 150mmHg or the diastolic blood pressure is greater than 130mmHg, 88.7% of the fundus changes, and when the systolic blood pressure is greater than 210mmHg, 100% of the fundus changes.
Generally divided into 3 phases, namely:
1 arterial sputum.
2 arteriosclerosis period.
3 retinopathy, some people think that it can be divided into the sputum and retinopathy, because the incidence of arteriosclerosis is low in this patient, and the fundus is quickly restored after termination of pregnancy, not necessarily hardening, and some patients do not undergo vascular sclerosis Directly into the retinopathy.
The most common and earliest changes in the fundus of pregnancy-induced hypertension are functional spasm and stenosis of the retinal arterioles, which can first invade one or more arteries. Functional contractions can be limited to one segmental arterioles with segmental spasm. Irregular, uniform contraction can narrow one or the entire fundus artery, and the ratio of arteriovenous can be changed from normal 2:3 to 1:2 or even 1:4. Since blood pressure continues to rise, blood vessels enter from functional contraction. To the organic hardening, it takes a long time for each report to be different. Some people think that it is no longer a sputum for more than 2 weeks, and some people think that hardening occurs in weeks or months. If the patient has hypertensive arteriosclerosis before pregnancy, More obvious, at this time, the artery is narrow, the reflection is enhanced, and some of the arteriovenous cross-pressure is still visible. Due to severe stenosis and narrowing of the artery, the vascular barrier is damaged, causing retinopathy, optic disc retinopathy and/or choroidal lesion. There are edema, hemorrhage and exudation in the paravascular retina. The exudation depends on the degree of retinal ischemia. The cotton disc-like plaque is mainly around the optic disc. The retinopathy can develop from the local to the entire fundus. And exudation, white lesions can be seen under the retina, indicating damage to choroidal capillaries and retinal pigment epithelium, severe serous retinal detachment can occur, the incidence is not high, at 0.6% to 2%, often off the bilateral Sexual, spherical, mostly located under the retina, exudate may come from the retina and choroid, or from the choroidal blood vessels alone, retinal detachment has a good prognosis, no surgery, self-reset within a few weeks after delivery, if the hypertension lasts for a long time, It can produce macular oozing, and severe cases can still produce optic disc edema. About 50% of patients have some degree of atrophy of the optic nerve and/or macular pigmentation disorder, which may seriously affect vision. The degree of visual decline depends on fundus lesions. Depending on the degree.
Examine
Examination of fundus lesions in pregnancy-induced hypertension syndrome
Pathological changes: ocular histopathological changes in pregnancy-induced hypertension are similar to those caused by other severe hypertension. The vascular changes in acute systemic hypertension are acute ischemia. In hypertensive retinopathy, retinal capillary stenosis, Capillary pericytes degenerate, and in most cases, retinal arterioles also have fibroid necrosis.
Fundus fluorescein angiography: retinal artery stenosis can be seen, capillary can be leaky and tissue staining, cotton-like plaque can have localized retinal capillaries without perfusion area, and some patients have delayed choroidal vascular filling around the posterior pole and optic disc. In patients with serous retinal detachment, the fluorescein fluorescein leaks and becomes thicker, suggesting that the choroidal capillaries and the retinal pigment epithelial barrier are damaged. The exuded fluorescein stains the subretinal fluid and stains around the optic disc. When the postpartum blood pressure drops, and the fluorescein angiography is performed after the retinal detachment is reset, there is no fluorescein leakage.
Diagnosis
Diagnosis and diagnosis of fundus lesions in pregnancy induced hypertension
According to the patient's medical history, symptoms, elevated blood pressure and fundus changes can be diagnosed.
