Delivery in Myopic Women: A Comparison of Mode of Delivery in Years 1990, 2000, and 2010

Abstract

BACKGROUND A belief has existed for many years that severe myopia is a direct indication for cesarean section or an instrumental vaginal delivery, although many academic papers negated this opinion. The aim of this study was to analyze the mode of delivery of myopic patients in the years 1990, 2000, and 2010. MATERIAL AND METHODS Medical records of 3027 women in labor from the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw were analyzed in 3 time periods: year 1990 - group 1 (G1), year 2000 - group 2 (G2), and 2010 - group 3 (G3). Maternal age, severity and proportion of myopia, ophthalmological consultations, and mode of delivery were assessed. RESULTS In G1 there were 992 patients, in G2 there were 1010 patients, and in G3 there were 1025 patients. Myopic women in labor accounted for 20% of G1, 12% of G2, and 20% of G3. The mean maternal age was ±29.4 years in G1, ±30 years in G2, and ±31.5 years in G3. Myopia was divided into 3 levels of severity depending on the degree of refractive error: low myopia -6 DS. The number of ophthalmological examinations needed in myopic patients to decide on the mode of delivery showed an increasing tendency over the evaluated years, but the rates of referrals for cesarean section/assisted delivery decreased. CONCLUSIONS The proportion of myopic women in labor receiving ophthalmological consultations showed an increasing trend over time. Despite publication of the Ophthalmology-Obstetrics Consensus of the Polish Society of Ophthalmology guidelines, myopia still remains an indication for cesarean section (cesarian section), but not to shorten the second stage of delivery.

Figure 1

The proportion of ophthalmological consultations and referrals for cesarean section or assisted delivery in myopic patients. There was a significant increase in ophthalmological consultations among myopic patients, from 5% in 1990 to 12.7% in 2000 and 19.9% in 2010 (p<0.0001, Mantel-Haenszel test). Referrals for cesarean section or instrumental delivery decreased significantly from 1990 to 2000 and from 1990 to 2010, but did not change significantly from 2000 to 2010.

Figure 2

The proportion of cesarean section or assisted delivery in myopic patients and patients without visual impairment stratified by year. The comparison of non-spontaneous vaginal delivery in parturients with myopia and without visual impairment (non-myopic) shows significant increases in both groups.