MYOPIA AND DELIVERY. Should mode of delivery be influenced by moderate and high myopia?

Cilj rada. Mnogi oftalmolozi i opstetričari još uvijek za dovršenje trudnoće odnosno poroda u žena s visokom miopijom preporučuju carski rez ili instrumentalni vaginalni porod, iako za to nema valjanih medicinskih dokaza. Budući da je u zdravstvenoj ustanovi autora došlo do promjene doktrine prema kojoj visoka miopija više nije predstavljala indikaciju za elektivni carski rez, cilj rada bio je istražiti je li spomenuta promjena imala ikakve implikacije glede zdravlja, osobito vida rodilje i perinatalnog ishoda. Namjera autora bila je dati preporuke glede stručnog postupanja s trudnicama i rodiljama koje imaju problem s umjerenom i visokom miopijom. Metode. U retrospektivnoj petogodišnjoj studiji međusobno su uspoređene skupine rodilja s niskom, umjerenom i visokom miopijom glede načina dovršenja jednoplodne terminske trudnoće i perinatalnog ishoda s osobitim osvrtom na eventualnu progresiju retinalnih promjena u majki neposredno nakon poroda. Rezultati. Studija je obuhvatila 240 rodilja, od čega 137 s niskom, 54 s umjerenom i 49 s visokom miopijom. Učestalost carskog reza iznosila je u prvoj ispitivanoj skupini 11%, u drugoj 14,8%, dok je u skupini rodilja s visokom miopijom učestalost carskog reza iznosila tek 10,2%. Između spomenutih rezultata nije bilo statistički znakovitih razlika, kao što ih nije bilo ni u odnosu na prosječnu učestalost carskog reza u Klinici u istraživanom razdoblju, koja je iznosila 10,1%. Ni jedan carski rez kao elektivni zahvat nije izvršen zbog miopije rodilje, bez obzira na njezinu vrijednost. Učestalost vakuum ekstrakcije u prvoj skupini rodilja s niskom miopijom bila je 5,1%, među rodiljama s umjerenom miopijom 1,9%, dok je učestalost vakuum ekstrakcije u skupini ispitanica s visokom miopijom iznosila 12,2% i bila je statistički znakovito viša u odnosu na učestalost u prve dvije skupine rodilja te u odnosu na prosječnu učestalost vakuum ekstrakcije u Klinici od 1,9% u istom razdoblju. Ni u jedne od skupina istraživanih rodilja nije nastala ablacija retine ni bilo koji drugi ozbiljan poremećaj vida. Zaključak. Uz gotovo jednaku učestalost carskog reza u skupinama rodilja s normalnim vidom, niskom, umjerenom i visokom miopijom nije se dogodio ni jedan slučaj akutnog pogoršanja vida u rodilje. Autori zaključuju da je spontani vaginalni porod kao prva opcija siguran način rađanja za rodilje s umjerenom i visokom miopijom te da planski carski rez u takvim slučajevima nikako nije opravdan.
Objective. Many obstetricians and ophthalmologists recommend in cases of preexisting high myopia either a cesarean section or an instrumental vaginal delivery, although these recommendations are not evidence based. According to a changed professional policy at author’s Department, moderate and high myopia were not indications for an elective operative delivery any more (since 2003). The aim of the study was to investigate did a changed obstetric policy had any implication on patient’s health, especially on vision condition, and perinatal outcome. Authors decided to give recommendations regarding optimal mode of delivery of pregnant women with moderate and high myopia. Methods. In a 5-year retrospective study a comparison between three groups of pregnant patients with low, moderate and high myopia regarding a mode of delivery of term single pregnancies and perinatal outcome is presented. Authors were interested particularly on eventual progression of retinal changes in mothers after deliveries. Results. The study encompassed 240 pregnant women. Out of total there were 137 patients with low myopia, 54 patients with moderate myopia, and 49 patients were highly myopic. The incidences of cesarean section in the studied groups of women were 11%, 14.8%, and 10.2%, respectively. There were not statistically significant differences either among the mentioned results or in relation to an average incidence of cesareans during the same study period, which was 10.1%. Not even a single elective cesarean was performed due to patient’s myopia of any degree. The incidences of instrumental vaginal deliveries with vacuum extraction were 5.1% in the group of women with low myopia, 1.9% in the group of patients with moderate myopia, and 12.2% in highly myopic group. The last result was significantly higher than the percentages of vacuum extractions in patients with low and moderate myopia, and in relation to an average incidence of vaginal deliveries with vacuum extraction during the same study period, which was 1.9%. Not a single case of either a retinal detachment or any other vision disturbance was recorded. Conclusion. With almost identical rates of cesarean section reported in the groups of eumetropic, low, moderate and high myopic puerperas, there was not even a single case of acute deterioration of patient’s visus. Authors concluded that spontaneous vaginal birth as a first option is an accurate mode of delivery for women with moderate and high myopia, and in those cases planned cesarean section is not justified.