Hyperemesis gravidarum with retinal hemorrhage

Abstract

This case presents the characteristic findings of severe hyperemesis with retinal hemorrhage except that, due to the comatose condition of the patient, visual disturbances could not be evaluated. It also illustrates the common pitfall of allowing temporary improvement to give one a false sense of security. We feel that, had she died, we might have been severely criticized for not interrupting the pregnancy twenty-four hours earlier. We cannot comment on the retrobulbar neuritis and other changes which Ballantyne indicates precede gross hemorrhage, inasmuch as we did not see the patient until retinal hemorrhage had developed. We concur with Stander that the hemorrhage is due to increased capillary permeability, associated with profound physical and chemical changes secondary to dehydration and inanition. These changes are reversible and not associated with permanent occular or cardio-vascular-renal damage. The etiology remains obscure. Prompt termination of the pregnancy resulted in complete recovery.