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Retinal detachment (was glaucoma and labor)From: Malcolm Griffiths (Malcolm@mgriff22.demon.co.uk)Sat Nov 22 02:53:28 1997
In message <34765AB0.24D2@club-internet.fr>, Bernard Cristalli <bcrist@club-internet.fr> writes >Jorge Carrillo wrote: >> >> Not only glaucoma is controversial between ophtalmologists and obgyn; try to >> put people together regarding miopy and labor. There are no evidence-based >> policies. >> >-- > >Right. Only when there is a history of retinal detachment (RD) it seems >reasonable to avoid efforts during the delivery. As well as when there >are lesions that may lead to this RD. A randomized trial sonds difficult >to be ethical, not to say it would be a *blind* test -/). > Bernard do you have any evidence for this statemetn about RD? It is a generally accepted view but as far as I am aware there is no evidence to support it. There was a short paper in BMJ a few years ago, which surveyed opthalmologists advice on elective assisted delivery or CS vs spont delivery for RD sufferers. The study showed a range of advice and discsussed the evidence for any interference and concluded that there was no evidecne and that there was no basis for interference. About 18mo ago I had a nurse-patient who had had an elective CS in her first pregnancy because of a past history of RD. Her opthalmologist and her then ob/gyn advised CS. Last time around she came to me asking for a trial of VBAC. I copied the BMJ paper to her opthalmologist and asked his comments. He confirmed he had no evidence to say a VBAC was inappropriate. She had a normal vaginal delivery without any problems! Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK. Tel: 01582-497459 (office) Fax: 01582-497376 01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk http://www.obgyn.net/board/griffith.htm "CLINICAL FREEDOM IS THE LAST REFUGE OF THE CLINICALLY INCOMPETENT!" (Someone [1997])
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