Effect of Uterine Fundal Pressure on Maternal Intraocular Pressure in Cesarean Delivery: Comparison of Regional and General Anesthesia

Kurtay, Aysun; Ozayar, Esra; Güleç, Handan; Yıldız, Gökhan; Türkyilmaz, Esra; Yıldız, Zennure Özdemir; Horasanlı, Eyüp

doi:10.1097/ijg.0000000000000687

Cited by 6 publications

(10 citation statements)

References 13 publications

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“…Although it has been found that fundal pressure, in order to facilitate delivery during C-section, does cause a small increase in maternal IOP. 83 This is contrary to what was believed earlier, but there is no clinical evidence in support of these findings.…”

Section: Stage-wise Management Plancontrasting

confidence: 76%

Management of glaucoma in pregnancy – balancing safety with efficacy

et al. 2021

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Glaucoma and pregnancy is an uncommon combination, but it constitutes a very challenging situation for the treating doctor. The challenge is not only controlling the intraocular pressure and preventing glaucoma progression in the mother, but also having to deal with her mental stress and anxiety regarding the safety of her child. The situation is further worsened by the lack of definite guidelines as to how to deal with such patients. Relative rarity of glaucoma in this population restricts any large prospective randomized clinical trials or any large systematic studies. Moreover, none of the existing anti-glaucoma medications is absolutely safe in pregnancy. Current practice patterns depend on some case reports, a few observational studies and a few animal studies that attempt at determining the safety and efficacy of the available medicines. These are then prescribed on the basis of their relative safety in any particular stage of pregnancy or lactation. Newer medications that were released recently in 2018, such as Vyzulta and Rhopressa, presently have limited data to support their safety for use during pregnancy. Laser trabeculoplasty, conventional filtration surgery (of course without anti-metabolites), and minimally invasive glaucoma surgery represent a few non-pharmacological management options. Surgical procedures such as trabeculectomy and tube-shunts or collagen matrix implants, and newer minimally invasive glaucoma surgery procedures such as the gelatin stents are currently being explored and may prove to be viable solutions for severe glaucoma during pregnancy, although they too have their own inherent drawbacks. Management of glaucoma during pregnancy and lactation requires careful consideration of the disease status, gestational stage, US Food and Drug Administration classification and guidelines, and potential benefits and limitations of the various therapeutic modalities. This review focuses on the importance of a multidisciplinary team approach, starting with preconception planning and counseling, determining the treatment options depending on the stage of glaucoma and of pregnancy, and emphasizes the involvement of the patients, their obstetrician, and pediatrician through active discussion regarding the various medical, laser, or surgical modalities currently available or under exploration for use during pregnancy and lactation. The ultimate aim is to achieve an optimal balance between the risks and benefits of any type of intervention, and to customize treatment on an individual basis in order to achieve the best outcomes for both mother and fetus.

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Section: Stage-wise Management Plancontrasting

confidence: 76%

Management of glaucoma in pregnancy – balancing safety with efficacy

et al. 2021

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“…Very few studies have been concerned with use of fundal pressure in CS. In study of Kurtay et al [6] they studied the Effect of Uterine Fundal…”

Section: Discussionmentioning

confidence: 99%

Comparison between Forceps, Single Blade Forceps and Manual Extraction of Fetal Head in Elective Caesarean Section: A Randomized Control Trial—Forceps Delivery in Cesarean Section

Wahab¹,

Aboulouz²

2018

OJOG

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Objective: The fundal pressure exerted by the assistant to deliver fetal head is often painful to the patient. This study assesses the use of double blade forceps in delivery of fetal head at time of elective Cesarean Section (CS). Methods: A prospective single-blinded randomized controlled trial was conducted among 150 women with repeat elective CS at Ain Shams university hospital, Air Force Specialized hospital and October 6 th university hospital. Women were classified into 3 groups (each 50 women). Forceps group: A double blade of forceps was used without fundal pressure. Single blade group: single blade of forceps was used assisted by fundal pressure. Manual group: manual extraction was used assisted by fundal pressure. The outcome of study were; Pain expectation score , pain score during delivery of head, unintended uterine extension, uterine vessels injury and need for additional stitches. The collected data were statistically analyzed using SPSS version 20. Results: High Statistically significant difference in pain score during delivery of head in favor of forceps group (P = 0.001). No differences were found among 3 groups as regarding pain expectation, uterine extension, uterine vessel injury and in need of haemostatic stitches (P > 0.05). Conclusion: Use of double blade forceps is less painful for the patients during delivery of head in CS.

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“…In a normal delivery, the mother facilitates delivery through the birth canal by the Valsalva maneuver (16). It has been observed that, this maneuver can increase IOP by the mechanism of increasing intrathoracic pressure followed by the jugular and orbital vein congestion (17). In addition, in some patients, holding their breath affects the IOP by increasing intrathecal pressure.…”

Section: Key Pointmentioning

confidence: 99%

“…Some obstacles to vaginal delivery may include myopia, retinal detachment, diabetic retinopathy and glaucoma (15). However, according to previous studies, there is no definite indication in the field of ophthalmology to determine the type of delivery (17), which concerns obstetricians treating women with eye diseases (10).…”

Section: Key Pointmentioning

confidence: 99%

The effect of delivery type (vaginal delivery versus cesarean section) on intraocular pressure and retinal nerve fiber layer thickness in healthy women

Nazari

2023

Immunopathol Persa

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Introduction: Pregnancy imposes physiological stress and significantly changes human body. This change may have potential effects on visual system. Little is known about pregnancy effects on intraocular pressure (IOP) and glaucoma. Objectives: The present study tended to evaluate and compare the effect of normal vaginal delivery (NVD) versus cesarean section (CS) on IOP and retinal nerve fiber layer thickness (RNFLT) in healthy women. Patients and Methods: Sixty pregnant women participated in this prospective cross-sectional study. The participants were assigned to two groups; the first group consisted of 30 candidates for NVD and the second group of 30 candidates for CS. Then, IOP in three states before delivery, during delivery, and six weeks after delivery then RNFLT were measured and compared by optical coherence tomography (OCT) in two states before delivery and six weeks after delivery. Results: Based on the results, there was no significant difference in the RNFLT in left and right eyes, before and after delivery in the NVD and CS groups (P=0.081 and P=0.090, respectively). Additionally, following the comparison of NVD and SC groups, no significant difference in the RNFLT between two groups was detected (P>0.05). According to IOP measurements in both eyes, IOP during delivery was significantly higher than before and after delivery in NVD group (P=0.05 and P=0.048, respectively) and CS group (P=0.028 and P=0.035, respectively). In addition, IOP in NVD group was higher than CS group in all states, but no statistically significant difference was seen among them (P>0.05). Conclusion: In general, the results showed that delivery type does not significantly affect RNFLT and IOP. It is also possible that an increase in IOP will lead to different results in women with pre-existing glaucoma or risk factors for it. Therefore, in cases with a positive background of glaucoma, specialized examinations and delivery under the supervision of a specialist are recommended.

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Effect of Uterine Fundal Pressure on Maternal Intraocular Pressure in Cesarean Delivery: Comparison of Regional and General Anesthesia

Abstract: In conclusion, fundal pressure may significantly increase the IOP, but the choice of anesthetic technique may not have any effect on IOP.

Cited by 6 publications

References 13 publications

Management of glaucoma in pregnancy – balancing safety with efficacy

Management of glaucoma in pregnancy – balancing safety with efficacy

Comparison between Forceps, Single Blade Forceps and Manual Extraction of Fetal Head in Elective Caesarean Section: A Randomized Control Trial—Forceps Delivery in Cesarean Section

The effect of delivery type (vaginal delivery versus cesarean section) on intraocular pressure and retinal nerve fiber layer thickness in healthy women

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