Einfluss des Geburtsmodus auf vorbestehende Augenerkrankungen

Abstract

Many ophthalmologists and obstetricians recommend either an assisted vaginal delivery with forceps or vacuum extraction, or a Caesarean section in cases of pre-existing eye diseases, such as myopia, retinal detachment, glaucoma or diabetic retinopathy. This is mainly based on the increase of intraocular pressure during the final stage of labor. These recommendations, however, are not evidence-based. None of the published trials have reported any retinal changes after vaginal delivery. This report provides information on the influence of physiological changes on eye diseases during the final stage of delivery. In general eye disease is not an indication for an instrumental or operative delivery provided regular eye examinations (once each trimester) have been performed.

Ocular Changes During Pregnancy

“…Recommendations regarding delivery methods in women with pre-existing ocular disease are not evidencebased (40). The question whether a caesarean section should be performed for ophthalmological reasons is most commonly asked, in the authors' experience, in cases of glaucoma, myopia, peripheral retinal degeneration, and status post retinal detachment.…”

Retrospective evaluation of indications and birth results of cesarean section due to ophthalmologic diseases

“…It is thought that the acute increase in intraocular pressure and decrease in ocular perfusion related to the valsalva maneuver during vaginal delivery can cause optic nerve damage in glaucoma patients [12]. Cesarean section is recommended for patients with high grades of myopia or retinal degeneration based on the thought that vaginal delivery can trigger retinal detachment [13,14]. In the studies of Sochaet al and in our study, the most frequent cesarean indications are myopia and retinaldetachment.…”

“…In the studies of Sochaet al and in our study, the most frequent cesarean indications are myopia and retinaldetachment. However, there are no evident-based reports in the literature indicating that vaginal delivery is associated with retinal detachment or progression of glaucoma [13,14]. Animal experiments, observational and comparative studies covering the pre-and post-delivery periods in pregnant individuals with ophthalmologic diseases are required.…”

Particularities of myopia in pregnancy

“…These recommendations, however, are not evidence-based (21) . As far as we know, there are not so many published trials that have reported any significant adverse retinal changes after vaginal delivery, therefore preexisting eye disease is not an indication for instrumental or operative delivery (22) .…”