Is it safe for a patient with severe myopia and retinal thinning to give birth?

Vaginal Delivery is Safe for Patients with Severe Myopia and Retinal Thinning

Severe myopia with retinal thinning is NOT a contraindication to vaginal delivery, and cesarean section should not be performed solely for ophthalmologic indications. 1

Key Evidence Supporting Vaginal Delivery

The concern that Valsalva maneuvers during pushing might cause retinal detachment or worsening of retinal pathology has been thoroughly investigated and disproven:

• Prospective studies of high myopic patients (ranging from -4.5 to -15.0 diopters) who underwent spontaneous vaginal delivery showed no deterioration of pre-existing retinal degenerations, retinal breaks, or other pathology on postpartum examination. 2

• Women with the highest-risk retinal pathology—including history of retinal detachment, extensive lattice degeneration, and symptomatic retinal holes—showed no changes in retinal status after spontaneous vaginal delivery. 3

• Among 254 pregnant women with myopia screened ophthalmologically, those who delivered vaginally (including 69 women with retinal lesions) had no abnormalities detected on follow-up examination 3-6 months postpartum. 4

Pre-Delivery Ophthalmologic Assessment

While vaginal delivery is safe, appropriate screening is warranted:

• Perform comprehensive ophthalmologic examination including peripheral retinal evaluation during pregnancy to identify any degenerative lesions. 4

• Retinal lesions requiring laser photocoagulation should be treated prophylactically during pregnancy if identified, but this does NOT change the delivery route. 4

• The severity of myopia does not correlate with the presence or type of retinal lesions—degenerative changes have been found in patients with myopia ranging from -0.25 to -12.0 diopters. 4

Management Algorithm

For patients with severe myopia and retinal thinning:

1. Allow spontaneous vaginal delivery regardless of degree of myopia or presence of retinal thinning. 2, 3, 5

2. Do NOT recommend instrumental delivery (forceps/vacuum) or cesarean section based solely on ophthalmologic findings. 3, 5

3. Perform postpartum ophthalmologic examination to document retinal status, though deterioration is not expected. 4, 2

Common Pitfalls to Avoid

The outdated practice of preventing bearing down or performing operative delivery in high myopic patients persists in some regions (particularly former Soviet Union countries) despite lack of scientific evidence. 1, 2 This approach was based on the theoretical concern that increased intraocular pressure during Valsalva would damage the retina, but this has been definitively disproven. 2, 3

Cesarean section based on myopia alone subjects patients to unnecessary surgical risks (hemorrhage, infection, thromboembolism, future placental complications) without any ophthalmologic benefit. 1, 5

Special Considerations

• Some patients may develop transient retinal hemorrhages or macular edema postpartum, but these do not represent clinically significant complications requiring intervention or cesarean section. 6

• Obstetric indications for cesarean section should be evaluated independently and are unrelated to myopia status. 5

• Patients with history of retinal detachment surgery can also deliver vaginally—prior retinal surgery is NOT a contraindication. 5