One of the most important elements associated with increase in oncological outcome in children is fertility preservation for future. It is obvious that chemo and radio therapy used in cancer treatment aim to destroy tumor cells, but they also impact healthy tissues. The negative influence of these types of therapy can be observed in every patient's organ. One of the most serious complication of oncological treatment is reproductive impairment. This determinates directly mental and social state of the patient as well as quality of life after the treatment, particularly in adolescent. Commonly used methods of fertility preservation in female children are: freezing ovarian tissue or unfertilized oocytes. Among male children freezing of testicular tissue or ejaculated sperm are conducted. Described methods of fertility preservation among children and adolescents are on the experimental stage and none of them provide 100% effectiveness.
Recently, a growing tendency for cesarean birth has been noted both, in Poland and worldwide. Non-obstetric problems constitute a large part of indications for cesarean section. Many ophthalmologists and obstetricians still believe that high myopia, the presence of peripheral retinal degenerations, history of retinal detachment surgery, diabetic retinopathy, or glaucoma are indications for surgical termination of pregnancy. However, these recommendations are not evidence-based. The literature offers no proof that high myopia and previous retinal surgery increase the risk of retinal detachment during spontaneous vaginal delivery. There is only one indication for cesarean section in myopic patients, i.e. the presence of choroidal neovascularization, which can cause subretinal bleeding with acute visual loss. Prolonged and intensified Valsalva maneuver during labor in patients with an active proliferative diabetic retinopathy may be an indication for an elective cesarean section. Uterine contractions during the second stage of vaginal delivery lead to a marked elevation of intraocular pressure. Intraocular pressure fluctuations during the delivery may damage retinal ganglion cells, resulting in further progression of visual field. Thus, glaucoma associated with advanced visual field changes is the next ophthalmic indication for cesarean section. The report presents the current state of knowledge concerning the effect of pregnancy on pre-existing ocular disorders and the influence of physiological changes on the clinical course of these diseases during the stages of natural delivery. The authors discuss also the ophthalmic indications for cesarean section.
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