Study note
Obstetrics & GynecologyHypertensive Disorders in Pregnancy

Urinary and retinal findings in pre-eclampsia

THE CONTEXT
The investigations described for pre-eclampsia include assessment of proteinuria and ophthalmoscopic examination for retinal changes.

Proteinuria

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Proteinuria is the last feature of pre-eclampsia to appear.
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Proteinuria may range from a trace to copious amounts; at 10–15 g/L, urine may become solid on boiling.

Ophthalmoscopic findings in severe cases

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Retinal edema and arteriolar constriction may occur.
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The normal vein-to-arteriole diameter ratio of 3:2 may change to 3:1.
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Veins may show nicking where they are crossed by arterioles, and retinal hemorrhage may occur.

Grading of retinal changes

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Grade 0 denotes a normal fundus.
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Grades 1–2 include arteriovenous narrowing and angiospasm.
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Grade 3 includes edema, hemorrhage and exudates, representing retinopathy of pre-eclampsia.
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Grade 4 denotes papilledema.
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