THE COURSE OF PREGNANCY AND THE PECULIARITIES OF CHILDBIRTH WITH HIGH-GRADE MYOPIA

ABSTRACT

Myopia is the second most common eye disease. At reproductive age, women have moderate myopia - 23-30%, and high - grade myopia-7-11%. In the structure of extragenital diseases in pregnant women, myopia is 18-20%.

From January 1, 2021 to December 31, 2021, a retrospective statistical study of the medical history of n=42 women with a confirmed diagnosis of myopia was conducted at the Scientific Center of Obstetrics, Gynecology and Perinatology in Almaty.

The average age of pregnant women was 31.57±3.81 years. The condition of myopia was predominant in women with rebirthind, with a total specific weight of 66.66%. And the proportion of firstborn was 33.33%. In the third trimester, myopia was detected-n=23 (54.76%), in the second trimester – n=15 (35.71%), in the I – trimester – n=3 (7.14%). According to the data we found, cesarean section - n=19 (45.23%), physiological childbirth – n=23 (54.76%) was carried out in a woman. In the course of determining the delivery data, the total weight of babies born to pregnant women with myopia is 3471.92±350.33 g., height-53.95±2.86 сm, the value of the Apgar scale reached 8.41±0.73 points.

АННОТАЦИЯ

Миопия - второе по распространенности заболевание глаз. В репродуктивном возрасте у женщин наблюдается миопия средней степени - 23-30%, высокой степени - 7-11%. В структуре экстрагенитальных заболеваний у беременных женщин миопия составляет 18-20%.

С 1 января 2021 года по 31 декабря 2021 года в Научном центре акушерства, гинекологии и перинатологии в Алматы было проведено ретроспективное статистическое исследование истории болезни n=42 женщин с подтвержденным диагнозом миопия.

Средний возраст беременных женщин составил 31,57±3,81 года. Состояние миопия было преобладающим у женщин с повторными родами - 66,66%. Первородящие женщины составили 33,33%. В третьем триместре была выявлена миопия - n=23 (54,76%), во втором триместре – n=15 (35,71%), в I триместре – n=3 (7,14%). Согласно полученным нами данным, женщине было проведено кесарево сечение - n=19 (45,23%), физиологические роды – n=23 (54,76%). В ходе определения данных о родах общий вес младенцев, родившихся у беременных женщин с близорукостью, составил 3471,92±350,33 г., рост - 53,95±2,86 см, значение шкалы Апгар достигло 8,41±0,73 балла.

Keywords: pregnancy, myopia, ophthalmology, features of childbirth, eye diseases.

Ключевые слова: беременность, миопия, офтальмология, особенности родов, заболевания глаз

Introduction. Myopia (near sightedness) myopia is in second place among eye diseases [1]. At reproductive age, women have moderate myopia - 23-30%, and high myopia - 7-11% [1, 2]. In the structure of extragenital diseases in pregnant women, myopia is 18-20% [3].

The most common complications of myopia are: stretching of the cornea, impaired blood supply, the appearance of peripheral vitreochorioretinal dystrophies (PVHRD), including isolated retinal tears and retinal detachment [4].

The pathogenesis of complications in myopia is associated with stretching of the posterior segment of the eyeball. This leads to increased vascular fragility with retinal and vitreous hemorrhages. Slowly dissolving bleeding can lead to vitreous clouding. Of particular importance is the formation of a coarse pigmented focus in the macular region (Fuchs ' spot), which reduces visual acuity [2].

Impaired blood supply is associated with a decrease in the pulse and minute volume of blood circulating in the intraocular vessels, a decrease in the rheographic coefficient determining changes in the volumetric rate of blood flow in the uveal tract, a decrease in blood pressure in the central artery of the retina, a slowdown in blood flow in the eye and morphological changes in the The patient only notices changes in vision when complications such as retinal tears and detachment occur. Various flashes, thunderstorms, flying "flies" may appear in front of the eyes (this indicates the alleged signs of retinal rupture) [4].

According to the clinical guidelines, three degrees of myopia are distinguished: weak degree or I (up to 3.0 dptr), moderate degree or II (3.25-6.0 dptr) and high degree or III (more than 6.25 dptr) [5].

Arm: to characterize the clinical course and features of childbirth in pregnant women with myopia

Materials and methods: From January 1, 2021 to December 31, 2021, a retrospective statistical study of the medical history of n=42 women with a confirmed diagnosis of myopia was conducted at the "Scientific Center for Obstetrics, Gynecology and Perinatology" of Almaty.

Criteria for inclusion in the study: women aged 18-50 years with a diagnosis of myopia according to ICD-10 H52.1 (according to the International Classification of diseases). Exclusion criteria: women in the stage of chronic decompensation and women infected with HIV, with a registered case of death.

In accordance with the therapeutic protocol of the Ministry of health of the Republic of Kazakhstan №10 of July 4, 2014, the results of clinical data, age characteristics, conclusions of instrumental and laboratory research methods, Anamnesis, weight of the baby in labor, the value of the Apgar scale, complications, and data on the course of childbirth were analyzed.

Statistical methods were used that made it possible to verify the analyzed data, the accuracy of the differences between the average values (М±m), the arithmetic mean values were evaluated by the T – criterion of Studenten. the difference at the level of р˂0,05 was considered statistically reliable. Statistical edits were collected in the electronic application Microsoft Office Excel.

Results. The average age of pregnant women was 31.57±3.81 years (Table 1), by age ≤25 years n=7 (16.66%) – the average age is 23.48±1.4, between 26-30 n=6 (14,28%) – 27.62±1.63, 31-40 age -n=16 (38,09%) – 35.49±3.2, 41≥ age over n=12 (28,57%) – 43.75±3.94 made age. The mean for pregnancy parity was 3.47±2.3 (p<0.05) (Figure 1).

Table 1.

 Clinical data of researchers

Figure 1. The incidence of myopia among pregnant women (%)

The condition of myopia, as determined in Table 1, was predominant in women with rebirthind, with a total specific weight of 66.66%. And the proportion of firstborn was 33.33% (Table 1). In the third trimester, myopia was detected-n=23 (54.76%), in the second trimester – n=15 (35.71%), in the I – trimester – n=3 (7.14%) (p<0.05) (Figure 2).

Figure 2. Determination of myopia according to gestational age (%)

According to the analysis, data were analyzed to assess the frequency of major comorbidities among pregnant women with myopia (Figure 3), as a result, in n=36 women (85.71%) early gestosis, n=12 (28.57%) anemia, chronic pyelonephritis – n=13 (30.95%), varicose veins of the lower extremities – n=6 (14.28%), obesity – n=5 (11.9%), diabetes mellitus in n=2 (4.76%) cases met (p<0.05).

Figure 3. Occurrence of comorbidities in pregnant women with myopia (%)

In n=37 (88.09%) women, pregnancy went without complications. It should be noted that the presence of myopia does not affect the course of pregnancy, since such complications occur in women and other pathologies. According to our data, physiological pregnancy has no negative effect on myopia. Our opinion is consistent with the data of other authors [2, 5].

In addition, there is evidence that obstetric pathology, in particular preeclampsia (mild, moderate, severe), leads to pathological changes in the organ of vision [5, 6]. Since in preeclampsia, especially in severe degrees, it is about spasms of the arteries, thrombosis of the branches of the retina, bleeding, edema, all this creates the prerequisites for retinal detachment [3].

The problem of practicing doctors is that currently there is no consensus on the tactics of delivery of pregnant women with a high degree of myopia [1].

The data of a number of modern authors show that physiologically occurring pregnancy does not significantly affect the condition of the eye with myopic refraction, therefore, accordingly, indications for delivery in them should not be based on the degree of myopia [5]. Absolute contraindications to natural delivery according to ophthalmological indications are: for the first time detected or operated after 30-40 weeks of pregnancy; the presence of ROS in the only sighted eye; late performed restrictive laser coagulation of the retina for PVHD (on the eve of the expected delivery), when chorioretinal adhesions in the areas of laser coagulation have not yet had time to form [6]. One of the relative contraindications to delivery through natural pathways are previously operated regmatogenic retinal detachment (RRD), extensive zones of PVHD with the capture of an area of more than one quadrant of the fundus [6].

According to the data we found, cesarean section - n=19 (45.23%), physiological childbirth – n=23 (54.76%) was carried out in a woman (Figure 4). Therefore, the condition of myopia may not affect the condition of childbirth.

Figure 4. Indicator by method of delivery (%)

In the course of determining the delivery data, the total weight of babies born to pregnant women with myopia is 3471.92±350.33 g., height-53.95±2.86 сm, the value of the Apgar scale reached 8.41±0.73 points (p<0.05) (Table 2), these indicators correspond to the birth rates of a normal baby.

Table 2.

 Statistical data of researchers

Discussion. The problem of practicing doctors is that currently there is no consensus on the tactics of delivery of pregnant women with a high degree of myopia [1]. With high-grade myopia, specialists resolve the dispute about the method of delivery most often in favor of cesarean section. The purpose of this choice is to exclude the appearance of complications in the form of regmatogenic retinal detachment. However, the main factor in the development of this pathology is the presence of peripheral vitreochorioretinal retinal dystrophy (especially its most dangerous forms: latticed dystrophy, retinal rupture, retinoschisis without ruptures and mixed forms), which can occur with myopia of any degree or in its absence [3-5]. The problem is that PVHD is asymptomatic. It is impossible to diagnose pathology during a routine examination. Its detection is possible only with maximum drug-induced mydriasis using a Goldman three-mirror lens. In some cases, it is necessary to resort to the use of sclerocompression, which leads to a shift of the retina closer to the center, which allows for a more detailed examination of it [6]. All pregnant women must undergo an examination of the peripheral parts of the fundus at 10-14 weeks of pregnancy in order to timely diagnose PVHRD [5].

The data of a number of modern authors show that physiologically occurring pregnancy does not significantly affect the condition of the eye with myopic refraction, therefore, accordingly, indications for delivery in them should not be based on the degree of myopia. To do this, criteria should be used for the presence of prognostically dangerous forms of PVHD and the degree of their severity [8]. Therefore, the presence of myopia of more than 6.25 diopters in the normal ophthalmoscopic state of the retina should no longer be an indication for artificial delivery. Absolute contraindications to natural delivery according to ophthalmological indications are: for the first time detected or operated after 30-40 weeks of pregnancy; the presence of ROS in the only sighted eye; late performed restrictive laser coagulation of the retina for PVHD (on the eve of the expected delivery), when chorioretinal adhesions in the areas of laser coagulation have not yet had time to form [8, 9]. One of the relative contraindications to delivery through natural pathways are previously operated regmatogenic retinal detachment (RRD), extensive zones of PVHD with the capture of an area of more than one quadrant of the fundus [10].

Conclusion: A high percentage of surgical delivery for ophthalmological indications is a public health problem. We consider it extremely necessary to indicate a complete diagnosis, on the basis of which an obstetrician-gynecologist will decide on the method of delivery of a woman. We recommend reducing the number of cesarean sections in women with ophthalmic pathology due to its unreasonableness, as well as a higher risk of intra- and postoperative complications from cesarean section compared with the risk of retinal detachment.

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