title: Delivery recommendations for pregnant females with risk factors for rhegmatogenous retinal detachment.
abstract: OBJECTIVE
  High-risk pathologies for rhegmatogenous retinal detachment (RRD) in otherwise healthy pregnant females are not contraindications for spontaneous vaginal delivery. However, 74% of European obstetrician-gynecologist (OBGYN) respondents in 2008 recommended operative delivery for females at risk for RRD. This discrepancy is likely due to an older study suggesting a causal relation between Valsalva-like manoeuvres and RRD. The purpose of this study is to determine current delivery recommendations for healthy pregnant females with high-risk pathologies for RRD among Canadian ophthalmologists and OBGYNs.
  
  
  METHODS
  Anonymous prospective cross-sectional survey sent via electronic link in 2013. χ(2) test of proportions was used to compare delivery recommendations between the 2 specialties. Multinomial logistic regression was used to identify predictors for recommendations.
  
  
  RESULTS
  A total of 356 participants responded including 92 ophthalmologists and 27 trainees, and 185 OBGYNs and 52 trainees. For healthy pregnant females with previously treated retinal hole/tear or treated RRD, significantly more OBGYNs recommended cesarean section and significantly more ophthalmologists recommended spontaneous vaginal delivery. Length of practice and type of practice setting were significant predictors among obstetricians in their delivery recommendations.
  
  
  CONCLUSIONS
  This study is the first to include obstetricians, ophthalmologists, and their trainees in a survey of the recommended mode of delivery for pregnant females with risk factors of RRD. Our results suggest that obstetricians concerned about potential RRD in pregnant patients may be unnecessarily recommending operative management. Educational sessions on the risk for RRD with spontaneous vaginal delivery may reconcile the current differences in recommendations between ophthalmologists and obstetricians.
authors: Department of Ophthalmology and Vision Sciences.
authors: Hannah
authors: H
authors: Chiu
authors: Department of Obstetrics and Gynecology, University of Toronto; Department of Obstetrics and Gynecology, St. Michael's Hospital.
authors: Donna
authors: D
authors: Steele
authors: Department of Ophthalmology and Vision Sciences.
authors: Chryssa
authors: C
authors: McAlister
authors: Department of Ophthalmology and Vision Sciences; Department of Ophthalmology, University Health Network, Toronto Western Hospital, Toronto, Ont.. Electronic address: waiching.lam@utoronto.ca.
authors: Wai-Ching
authors: WC
authors: Lam
mesh_terms: D000328:Adult; D002170:Canada; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D009774:Obstetrics / Q000706:statistics & numerical data*; D009885:Ophthalmology / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications; D011446:Prospective Studies; D012163:Retinal Detachment / Q000209:etiology*; D012307:Risk Factors; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D000078329:Workforce