British vitreoretinal surgeons survey on experiences of retinal complications in females undergoing vaginal delivery with previous history of vitreoretinal surgery

Session Details

Session Title: Free Paper Session 6: Vitreoretinal Surgery II

Session Date/Time: Thursday 07/09/2017 | 14:30-16:00

Paper Time: 14:48

Venue: Room 111

First Author: : R.Jones UK

Co Author(s): :    S. Winder                             

Abstract Details

Purpose:

To collate Vitreoretinal surgeons experience in Britain on retinal complications in females undergoing vaginal delivery with previous history of Vitreoretinal surgery and thoughts on augmenting delivery due to retinal co-pathology.

Setting:

The Royal Hallamshire Hospital, Sheffield, UK

Methods:

SurveyMonkey® Survey sent to all British and Eire Association of Vitreoretinal Surgeons (BEAVRS) members, responses received between 5th October 2016 & 7th December 2016 and analysed. Four questions asked: Q1: Have you seen retinal complications following vaginal delivery in the mother? Q2: Have you seen retinal complications following vaginal delivery in a mother who has had previous retinal detachment surgery? Q3: What were the complications in such women? Q4: Is it your practice to advise female patients not to have vaginal delivery if she has previously had Retinal Detachment surgery?

Results:

Sixty seven replies. Of responders 94.03% had not seen any retinal complications following delivery in the mother. 100% had not seen any retinal complications following vaginal delivery in mothers who have had previous retinal detachment surgery. Retinal complications seen in the mother following vaginal delivery include: - Valsalva retinopathy and Proliferative diabetic retinopathy - Macular haemorrhage after vaginal delivery secondary to Choroidal Neovascular Membrane - Pre-existing optic disc pit developed a maculopathy - Retinal haemorrhage. 98.51% of responders do not advise against vaginal delivery if the mother has had previous retinal detachment surgery.

Conclusions:

A 2011 article surveyed obstetric opinions to assess preferred methods of delivery in women that have had prior surgery for retinal detachment. Results from the survey showed 76% of Obstetricians would recommend assisted delivery (caesarean section/ instrumental delivery) and 13% would ask for ophthalmic advice. A 2010 article reviewed indications for caesarean sections performed; of 4895 patients undergoing caesarean sections, 100 (2.04%) presented a written certification from an ophthalmologist suggesting surgical delivery. The most common ophthalmological disorders indicating caesarean delivery in this study included myopia (57%), retinopathy (20%), glaucoma (5%), imminent retinal detachment (4%) and past retinal detachment (3%) and in 45% of these patients an ophthalmic pathology was the sole reason for a caesarean section From this survey British Vitreoretinal opinion is that prior vitreoretinal surgery in an expectant mother should not warrant assisted or surgical delivery, if there were no other systemic features requiring altering from a vaginal birth.

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