The authors examined 100 unselected pregnant women with EPH gestosis of different severity using the Keith-Wagener classification. In 52 women no fundus changes were observed; first-degree changes were seen in 32 women and second-degree changes in 10. Six gravidae presented with third or fourth-degree fundus changes. The average gestosis index was almost identical in the group without fundus changes and in the groups with first and second-degree hypertensive retinal changes, but significantly higher in the group with severe fundus changes (third or fourth degree). There was a clear correlation between the hypertensive fundus changes and blood pressure at the time of examination, in particular with regard to systolic blood pressure. An apparently normal fundus did not exclude the presence of a severe EPH gestosis; on the other hand severe retinal changes were sometimes seen in women with only mild EPH gestosis. Examination of the fundus in patients with EPH gestosis permits an objective assessment of vascular changes and provides a basis for further obstetric management.