Is Cesarean Delivery Safer for Patients with High Myopia?

Is cesarean delivery suitable for individuals with high myopia?

Dear Dr.
Chang: I once read a report in the newspaper stating that "patients with high myopia are at a higher risk of retinal detachment if they undergo vaginal delivery." I currently have a myopia of -8.50 diopters in both eyes and am six months pregnant.
I am wondering if choosing a cesarean section would be more beneficial in my case, as hospitals generally encourage avoiding cesarean deliveries.
However, I am afraid that natural delivery could indeed lead to retinal detachment! What is the likelihood of retinal detachment occurring due to vaginal delivery? Approximately what percentage is it? I feel so uncertain!

Xiao Qi, 30~39 year old female. Ask Date: 2007/02/24

Dr. Zhang Yanrui reply Ophthalmology

Labor requires increased abdominal pressure, which theoretically could have an adverse effect on the occurrence of retinal detachment.
However, current scientific research has not found a correlation between the two.
Therefore, given your condition, if there is any degeneration or holes in the retina, it is advisable to perform laser repair before delivery; once repaired, the risk of detachment is significantly reduced.
The laser used is visible light and has no penetrating power, so it does not affect fetal development.
Generally speaking, high myopia is not a natural contraindication, and the likelihood of retinal detachment occurring due to vaginal delivery is extremely low.

Reply Date: 2007/02/24

More Info

When considering the safety of delivery methods for patients with high myopia, particularly those with severe myopia (greater than -6.00 diopters), it's essential to weigh the risks and benefits of both cesarean delivery and vaginal birth. High myopia is associated with an increased risk of retinal complications, including retinal detachment, especially during the stress of labor and delivery.

Research indicates that the risk of retinal detachment during or after vaginal delivery in patients with high myopia is a concern, but the exact percentage of risk can vary. Some studies suggest that the risk of retinal detachment in high myopia patients during vaginal delivery may be around 1-2%, but this can be influenced by various factors, including the degree of myopia, the presence of other ocular conditions, and the specifics of the delivery process itself.

Cesarean delivery, on the other hand, is often recommended for patients with severe myopia to mitigate the risk of retinal detachment. The rationale behind this recommendation is that the increased intraocular pressure and physical strain during contractions can potentially lead to complications in those with pre-existing retinal vulnerabilities. However, cesarean delivery is not without its own risks, including surgical complications, longer recovery times, and potential impacts on future pregnancies.

It's important to note that while cesarean delivery may reduce the risk of retinal detachment, it is not a guarantee that complications will not occur. Each case should be evaluated individually, taking into account the patient's overall health, the degree of myopia, and any other risk factors that may be present.

In your situation, since you are currently 6 months pregnant and have a high degree of myopia (850 degrees), it would be prudent to have a thorough discussion with your obstetrician and an ophthalmologist. They can provide personalized advice based on your specific circumstances, including any changes in your vision or eye health during pregnancy. They may also recommend a comprehensive eye examination to assess the health of your retina and determine if there are any additional risks that need to be addressed.

Ultimately, the decision regarding the mode of delivery should be made collaboratively between you and your healthcare providers, considering all risks and benefits. If you have concerns about the potential for retinal detachment during vaginal delivery, expressing these concerns to your healthcare team can help them understand your perspective and guide you toward the safest delivery option for you and your baby.
In summary, while cesarean delivery may be safer for patients with high myopia in terms of reducing the risk of retinal detachment, it is essential to consider the individual risks and benefits of each delivery method. A multidisciplinary approach involving obstetricians and eye specialists will provide the best outcome for both your eye health and your pregnancy.

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It is advisable for you to further discuss the above situation with your ophthalmologist and obstetrician. Thank you, and wishing you good health!