THE ROLE OF AN OPHTHALMOLOGIST IN THE EXAMINATION OF PREGNANT WOMEN: ANALYTICAL REVIEW OF SCIENTIFIC LITERATURE
DOI:
https://doi.org/10.24144/2077-6594.3.2019.191645Keywords:
ophthalmologic status, eye diseases, pregnancy, extragenital complications, myopia, vitreochorioretinal dystrophy, preeclampsiaAbstract
Aim: consider the clinical features of the examination of the ophthalmologic status pregnant women, identify the most common ophthalmologic diseases and complications associated with pregnancy and childbirth, determine the tactics of pregnancy and childbirth.
Materials and methods: dates of medical literature in library of Thanscarpathian regional medical informational and analytical center, sources of the Internet.
Results. The problem of the organ of vision occurs quite often. The main tasks for an ophthalmologist who examinates pregnant women include: diagnosis of primary pathology of the organ of vision, especially those that may have a negative prognosis in terms of maintaining vision at self-childbirth, assessment of the condition of the fundus and detection of signs of preeclampsia There are 3 groups of patients taking into account the features of ophthalmic examination of pregnant women: the first one is – physiological pregnancy without pathology of the organ of vision; group II – physiological pregnancy with a pathology of the organ of vision in the anamnesis, such as myopia, peripheral vitriochoreretinal dystrophy,retinal detachment, vitreous, vascular and other; group III is a pathologically progressive pregnancy with a pathology of the organ of vision that has arisen as a result of pregnancy complications such as preeclampsia, anemia, gestational diabetes mellitus and the like. During the pregnancy, a woman should be examinate two times with an ophthalmologist: 1st – in the first trimestr of pregnancy – 12–14 weeks; 2nd – in the third trimester – 30–32 weeks. The third examination is not compulsory for all pregnant women, but those who have a pathological pregnancy. The examination should be performed under conditions of maximal medicated mydriasis, which allows to visualize the peripheral parts of the fundus and to eliminate the presence of dystrophic changes. Monitoring of pregnant women with myopic refraction is very important. The problem of myopia is relevant because of the fact that the presence of high degrees of myopia leads to questions about childbirth tactics. Some authors claim that not the degree of myopic refraction, but the presence of potentially dangerous forms of peripheral vitrechoreoretinal dystrophy determines the risk of rheumatogenic retinal detachment during pregnancy and childbirth. Laser coagulation of the retina allows to minimize the risk of retinal detachment. That’s why, in the detection of peripheral vitrechorioretinal dystrophy in pregnant women, it is necessary to do preventive laser coagulation of the retina. Most authors think that it is possible to allocate absolute and relative indications to Caesarean section because of pathology of the organ of vision. The problem of choosing the optimal correlation between the risk of loss of vision during physiological childbirth and the possible development of intra- or postoperative complications due to cesarean section is actual.
Conclusions. Ophthalmologic examination of pregnant women has a number of features. It is necessary to differentiate the physiological manifestations of pregnancy from pathological. Even when an ophthalmologist gives an opinion on the method of woman's childbirth, the gynecologist finally makes the decision in each situation.
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