CSC is a known pregnancy-related complication, although previous reports of CSC during pregnancy have been associated with pregnancy-induced hypertension (PIH), where CSC is thought to result from choroidal ischaemia.1 2
Other reports have been in association with HELLP syndrome (Haemolytic anaemia, Elevated Liver enzymes and Low Platelets),3
which is related to severe PIH. CSC can occur in any trimester of pregnancy, can be unilateral or bilateral, and usually resolves by the end of pregnancy or soon after delivery. On rare occasions, it has been reported in the postpartum period, up to 4 weeks after delivery, similarly in association with underlying systemic pathologies. There are no reports of CSC occurring during an uncomplicated pregnancy, or with symptom onset intrapartum. Our patient had no antepartum history suggestive of PIH or HELLP. However, as a result of her reduced visual acuity which was first noted during childbirth, she was admitted by the obstetric team for several days following delivery, and during this time was thoroughly investigated for an underlying systemic pathology that could have been responsible for her symptoms. Clinical observations and examination findings during the admission were not suggestive of either PIH or HELLP, and similarly, haematological and biochemical parameters, as well as urinalysis results were not consistent with either pathology. This led us to believe that the CSC may have developed through an alternative mechanism in this patient. Recent studies using indocyanine green angiography suggest that the possible primary pathology in CSC is in the choroidal vessels,4
and that venous congestion can lead to hyperpermeability of choroidal vessels resulting in CSC.5
Our patient reported pushing for an extended period during the second stage of labour (almost 3 h), and we therefore suggest that the resulting raised venous pressure and subsequent venous congestion may have caused her to develop CSC.
In summary, it appears that CSC can occur during labour. Anecdotally, blurred vision is often reported postpartum, but there is a notable lack of OCT studies on such patients, and symptoms are frequently attributed to hormonal changes, particularly as they resolve spontaneously over time following delivery. Our finding implies that ocular imaging of women with such symptoms may be warranted in establishing a diagnosis and supporting our observations.
- Central serous chorioretinopathy (CSC) is a known complication of pregnancy in patients with underlying disease or obstetric complications.
- Our patient demonstrates that CSC may also occur in a healthy woman with an uncomplicated pregnancy, and we propose that this may be due to the process of childbirth itself.
- Blurred vision is often reported by women following childbirth, but is rarely investigated, particularly as it has a tendency to settle spontaneously.
- Our report suggests that CSC following childbirth may be more common than realised, and that a thorough eye examination should be performed in such patients to ensure a diagnosis is not missed.