Is vaginal delivery harmful to patients with pseudoxanthoma elasticum?
Risseeuw, Sara; Yildirim, Hilin; Spiering, Wilko; Imhof, Saskia M.; Van Leeuwen, Redmer; Ossewaarde-Van Norel, Jeannette
(2022) Retinal Cases and Brief Reports, volume 16, issue 4, pp. 422 - 425
(Article)
Abstract
Background/Purpose:To investigate the effect of a vaginal delivery (VD) on retinal pathology in patients with pseudoxanthoma elasticum.Methods:Retrospective case series. All 14 consecutive women with pseudoxanthoma elasticum who visited the ophthalmology department during pregnancy and after delivery between 2010 and 2018 were included. Prepartum and postpartum imaging consisted of color imaging,
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near-infrared imaging, and optical coherence tomography and was assessed on occurrence of (sub)retinal hemorrhages and change in angioid streaks.Results:Fourteen patients (15 deliveries) were included, of whom 11 patients (79%) had a VD and three patients (21%) a secondary caesarian section. Data of three patients with VD (four deliveries) could not be assessed for (sub)retinal hemorrhage within 10 weeks postpartum. The median age at delivery was 31 years (IQR 29-37). One patient with VD (9%) had a choroidal neovascularization and was treated with anti-VEGF injections before assisted delivery. All patients had angioid streaks in the central 5,500 µm of the posterior pole of both eyes. After delivery, no patient in the VD or caesarian section group presented with progression of angioid streaks or (sub)retinal hemorrhage.Conclusion:Pushing during the expulsion phase of VD seems safe in pseudoxanthoma elasticum patients without active choroidal neovascularization, and the presence of angioid streaks alone should not be an indication for elective caesarian section.
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Keywords: Angioid Streaks/complications, Choroidal Neovascularization/drug therapy, Delivery, Obstetric/adverse effects, Female, Fluorescein Angiography, Humans, Intravitreal Injections, Pregnancy, Pseudoxanthoma Elasticum/complications, Retinal Hemorrhage, Retrospective Studies, Tomography, Optical Coherence, Visual Acuity, Journal Article
ISSN: 1935-1089
Publisher: Lippincott Williams and Wilkins
Note: Funding Information: The author was supported by unrestricted grants from Stichting Vrienden UMC Utrecht, Stichting Rotterdamse Blindenbelangen, Stichting PXE-fonds and the Dr. F.P. Fischer Stichting. These foundations had no role in the design or condict of this research. Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.
(Peer reviewed)