Observations on hypertensive toxaemia of late pregnancy with special reference to eyeground changes therein

Abstract

The term "Toxaemia of Pregnancy" in its broadest sense includes a number of diverse conditions with no feature in common but that they occur in the gravid state. Hyperemesis gravidarum, acute yellow atrophy of the liver, chorea gravidarum, essential hypertension, chronic nephritis, pre -eclampsia, and eclampsia are all loosely grouped together under this accommodating heading regardless of the fact that some are not toxaemias at all, some may be concurrent with pregnancy and not consequent upon it, and some are neither toxaemic states nor are they exclusively associated with pregnancy.

This paper only concerns the hypertensive toxaemias of late pregnancy - that is to say, cases which in the last trimester show a pathological degree of hypertension. Such a standard is inevitably an arbitrary one, but this is unavoidable. It does not exclude cases of essential hypertension and chronic nephritis because their absolute exclusion has been found impossible, but obvious and gross cases antedating the pregnancy have been omitted from the series.

The remaining cases, practically all of whom apparently developed hypertension as a direct result of their pregnancy, have not been classified in any way. It would appear that until the notorious number of theories concerning late pregnancy toxaemia are finally discarded, and until one is proven and accepted, attempts at classification are unscientific and as fruitless as were the vain efforts of many workers to isolate a specific toxin responsible for the condition.

These theories are so numerous, and the literature concerning them so overwhelming and contradictory that a complete survey is impossible. A summary, however, of the principal facts on which the various theories are based may be attempted.