Analysis of influencing factors of severe preeclampsia with exudative retinal detachment and study of pregnancy outcome / 中华眼底病杂志

ABSTRACT

Objective:To observe and preliminary investigate the influencing factors of exudative retinal detachment in patients with severe preeclampsia (S-PE) and its influence on pregnancy outcome.Methods:A total of 89 patients of S-PE patients diagnosed in Department of Obstetrics in The Third Central Hospital of Tianjin from July 2018 to June 2020 were included in this study. According to whether the patients were complicated with exudative retinal detachment, they were divided into retinal detachment group (43 cases) and non retinal detachment group (46 cases). All patients underwent direct ophthalmoscopy, and those with suspected or definite retinal detachment underwent optical coherence tomography or B-mode ultrasonography. The age, course of disease, body mass index, systolic blood pressure, diastolic blood pressure, laboratory serum albumin level, 24 h urinary protein, platelet count, mean platelet volume, platelet distribution width and serum uric acid content were collected. The average age ( t=-1.01), body mass index ( t=-1.799), course of disease ( t=-1.657) and constituent ratio of primipara and multipara in the two groups were compared ( χ2=1.411), the difference was not statistically significant ( P>0.05). The end of pregnancy time, systemic complications, fetal outcomes and neonatal Apgar scores were analyzed, retrospectively. Independent sample t test was used to compare the quantitative data between the two groups; Chi square test was used to compare qualitative data. Binary logistic regression analysis to screen the influencing factors of exudative retinal detachment in S-PE. Results:Systolic blood pressure and diastolic blood pressure were higher in the retinal detachment group than in the non retinal detachment group, and the difference was statistically significant ( t=2.087, 2.810; P=0.040, 0.006). Serum albumin ( t=-10.404), 24-hour urinary protein quantification ( t=6.401), blood uric acid ( t=3.910), platelet count ( t=-6.124) and platelet distribution width ( t=2.992) were compared between the two groups, and the differences were statistically significant ( P<0.05). There were 30 (69.77%, 30/43) cases in retinal detachment group and 14 (30.43%, 14/46) cases in non retinal detachment group with severe systemic complications; The average time of ending pregnancy was 34.66±3.29 and 38.25±1.62 weeks; The average Apgar scores at birth were 7.28±3.40 and 9.46±1.59. The incidence of severe systemic complications in two groups ( χ2=13.755), the end of pregnancy time ( t=-6.448), Apgar score at birth ( t=-3.824), the differences were statistically significant ( P=0.000、0.000、0.000). Fetal distress and death were 8 (18.60%, 8/43), 7 (16.28%, 7/43) and 7 (15.22%, 7/46), 1 (2.17%, 1/46) in retinal detachment group and non retinal detachment group respectively. There was no significant difference in the incidence of fetal distress between the two groups ( χ2=0.182, P=0.670). The difference of fetal mortality was statistically significant ( P= 0.027). Logistic regression analysis showed that serum albumin and uric acid were associated with exudative retinal detachment in patients with S-PE ( P<0.05). Conclusions:Serum albumin and uric acid are the influencing factors of exudative retinal detachment in patients with S-PE. Patients with exudative retinal detachment are prone to adverse pregnancy outcomes.