Research on pregnancy and birth for older mothers does tend to confirm the view that these women are more likely to experience complications. However, it is important to look at the type of complications which were experienced; are they things which mean that emergency intervention in a spontaneous labour is more likely to be needed, or are they complications which you would know about before labour starts? And if your pregnancy is uncomplicated, does being an older mother really put you at any higher risk once you go into labour?
My review of the research so far suggests that most of these complications are either things which are diagnosed antenatally, allowing the mother time to change her plans if necessary, or involve slow progress in labour, allowing time to transfer to hospital. It is still possible that there is an increased risk of emergency complications in labour, but I have not been able to confirm this. At least one study found no increase in emergency caesarean section for older mothers, for example. However, whether there is an increased risk or not, it is vital to remember that it is up to each individual mother whether she decides to plan a home birth or not; it is not up to anybody else to presume to "allow" her to have a home birth.
On this page you will find a brief discussion of complications which are more common in older mothers, after a list of birth stories:
Dunja was 36 when her baby was born at home in Spain.
"Where there are no tangible medical complications of pregnancy, the risks of childbirth in older women are no greater than in younger women"
- Editorial, British Journal of Obstetrics and Gynaecology, Volume 108, Issue 9, September 2001
In September 2001, the British Journal of Obstetrics and Gynaecology published a study which found that the high levels of obstetric intervention experienced by older mothers were not explained by actual complications which developed in their pregnancies or labours. These women underwent more inductions, caesareans, assisted deliveries, and augmentation of labour (having labour speeded up with an oxytocin drip) than younger women, even after adjusting for complications. Although the women's own requests might have had some influence on this, the attitudes of their caregivers must surely have been important too.
The journal's editorial, aimed at obstetricians, makes this clear:
Our fears concerning increasing maternal age in pregnancy arose from unsophisticated surveys conducted many years ago which showed an apparent increase in risk; these surveys did not have the capacity to adjust adequately for confounding variables. Yet the teaching is handed down, that older women are at a higher risk in pregnancy and childbirth.
How often have you seen "Elderly Primigravida" written in the Special Features column of the maternity record? This will convey a subliminal message to the obstetrician and midwife caring for the woman in labour, which will colour their judgments, and lead inevitably to a caesarean section.
Where there are no tangible medical complications of pregnancy, the risks of childbirth in older women are no greater than in younger women. There are many other examples in obstetric practice where a survey suggests that an outcome, rare in itself, may be more common in women with a certain characteristic, which results in many women receiving unnecessary and often unpleasant treatment.
Editor's Choice, by John M Grant
British Journal of Obstetrics and Gynaecology
Volume 108, Issue 9, September 2001
I have to confess that I would not agree with the whole of this editorial, as other parts talk about how important it is for women to give birth in the largest obstetric unit possible on the grounds that some recent research has shown that these may be safer than small maternity units. However, as no comment is made about home birth, and as we know from ample research that home birth safety compares very well with outcomes for all maternity units, I feel it is ethical to use the extract above!
In the case of premature labour, it should not make any difference whether you are a 45 year-old primigravida or a 25 year-old mother of two. In both cases, if you went into labour at 34 weeks, you would transfer to hospital. In fact, since the old primigravida is apparently more likely to be given oxytocin to speed up her labour, she could be at an advantage here as she would have more time to transfer to hospital. The risk of premature labour does not seem to have any bearing on whether one should book a home birth or not; if you go into premature labour, you go to hospital. If you do not, then this risk is irrelevant to you.
Pre-eclampsia can, occasionally, occur for the first time during labour, but it is usually diagnosed in pregnancy. The mother can then decide whether she believes that her condition warrants induction of labour, or whether she would rather wait and see, and monitor her own and her baby's condition. Again, it is a condition which one would need to worry about IF it occurred, but if the older mother does not have pre-eclampsia, then she does not need to change her plans for a home birth. In the case of a sudden blood pressure rise in labour, she could transfer to hospital just as any mother could. It would be interesting to know what proportion of cases of pre-eclampsia are first diagnosed in labour, and if I find more information I will note it here.
Antepartum haemorrhage is a term used to describe bleeding from the genital tract after the 24th week of pregnancy (Mayes' Midwifery, p522). Bleeding during labour is sometimes called 'intrapartum haemorrhage'. Antepartum haemorrhage may occur because of placenta praevia or an abrupted placenta - where the placenta partially or wholly detatches from the wall of the uterus. Placenta praevia can be diagnosed antenatally and is routinely checked for in ultrasound scans - it occurs when the placenta implants over the cervix, and in cases of true placenta praevia, caesarean delivery is necessary.
Where bleeding occurs before labour, the mother who has planned a home birth is in exactly the same situation as the mother who has planned a hospital birth - she goes into hospital. The issue for home births is intrapartum haemorrhage, where the home birth mother must transfer to hospital, as a caesarean section is necessary if the bleeding is severe. The abstracts I have found do not tell us whether the older mother is at increased risk of intrapartum haemorrhage or not - just that she is of increased risk of antepartum haemorrhage overall. If there is an increased risk of intrapartum haemorrhage then it obviously increases the likelihood that the mother will need an emergency transfer to hospital. However, in order to make an informed decision it would be necessary to find out a) whether INTRApartum haemorrhage is more likely, and b) just how likely it is, and c) what transfer times are in your area.
Older mothers, particularly those having first babies, are apparently more likely to have slow progress in labour, which is treated in hospital by an oxytocin drip, possibly ending in an assisted delivery or a caesarean section. Slow progress in labour is not an emergency situation - when labour does not progress well, the mother can decide, in her own, to transfer to hospital for assistance or an epidural if she is tired. It would be disappointing to transfer from a planned home birth in this way, but it is up to each individual to decide if she wants to risk this disappointment. See Transferring to hospital from a planned home birth and First Babies and Home Birth for more information.
Breech presentation - if your baby is breech, you can research and decide how to proceed. If your baby is head-down, then the higher risk of breech babies for older mothers should make no difference to your plans for a home birth. The same applies to transverse and oblique babies.
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Lesley Ann Page discusses research on older mothers in her book, "The New Midwifery - science and sensitivity in practice" (Churchill Livingstone, 2000). She makes the following points on pages 58-59.
1. The idea that a group of women are at increased risk of intervention in labour can become a self-fulfilling prophecy, as birth attendants are more anxious and so intervene more, or perceive problems where they might not have done with a lower-risk mother.
2. Studies on maternal age and risk are often confounded by other variables - eg older women are more likely to have pre-existing health problems such as high blood pressure, but their outcomes are lumped together with those of older mothers who are healthier.
3. Older women are treated as higher-risk and so are more likely to have continuous electronic foetal monitoring, which has been shown to increase the intervention rate without necessarily improving outcomes.
Page reviews a study by Rosenthal and Brown, the abstract of which is reproduced below at [23], and finds that its methodology is lacking because of, for example, poorly-defined subjective criteria, and lack of adjustment for confounding variables.
[0] Older women were more likely to experience intervention in their labour and birth, even after adjusting for complications of pregnancy. The level of intervention received by older mothers was not explained by the complications they actually experienced.
[1] Women having first baby at 35+ are at higher risk of pre-existing hypertension, ie they were more likely to have blood pressure problems BEFORE pregnancy. Also increased risk of antepartum haemorrhage (bleeding before birth), preterm labour, and breech presentation. These are the important factors as they are not likely to be affected by the doctor's worries about the mother's age. The study also found that older first-time mothers were more likely to end up with induction, operative delivery, and epidural - my view is that these last three are things which would be influenced strongly by the views and concerns of the health professionals and the mother, rather than necessarily by differences in the actual wellbeing of mother and baby.
This study found NO increased risk of pre-eclampsia, gestational diabetes, postpartum haemorrhage, postpartum haemorrhage (bleeding after the birth), or babies born in bad condition (low APGAR scores, need for resuscitation).
[2] Women having first baby at 35+ are at increased risk of caesarean section. This was particularly evident in older mothers expecting larger than average babies - at 3,600g (7lb 13oz) and over. The authors thought this difference could not be accounted for by differences in doctors' attitudes. Women who had oxytocin to speed up their labours, or who had epidurals, were also more likely to end up with caesareans.
[3] This study compared women having their first baby at 40+ to those having subsequent children at 40+. First-time mothers were more likely to have antepartum haemorrhage or blood pressure problems. Looking at factors which can be influenced by doctors' attitudes, the study found that older first-time mothers were more likely to be induced and to have a caesarean section (58.8% c/s rate for first-time mothers!!). However, there was no difference between the outcomes for babies - the children of older first-time mothers did just as well as the children of mothers on their second or later babies.
[4] Looked at 59 women having first baby at 40+, compared to women aged 20-30. Older mothers were at more risk for premature labour, pre-eclampsia, and c-section (47% versus 12% !!!). They were more likely to have babies with abnormalities (surprise, surprise!). It looks likely that this, and the prematurity rate, would account for the higher perinatal mortality (babies dying) in the older mothers' group, but it's not possible to tell from the abstract.
[5] Very relevant to women considering home birth, this study looked at first-time mothers 35+ who, after uncomplicated pregnancies, were booked for midwife care in the Netherlands. They found that there was a higher rate of transfer to obstetric care in labour, but this was nearly always for slow progress in labour - ie not an emergency situation. The authors conclude:
"after selection, the elderly nullipara, under the care of a midwife, does not have an increased risk of fetal distress or other emergency factors compared to the younger nullipara. However, the referral rates during labour, both of younger and older women, are high. "
[6] It looks like the authors of [5] expanded their study and published again the following year. Over a larger number of women, they found that actually 'elderly' first-time mothers were no more likely to be transferred from midwife-care to obstetric care than younger first-time mothers. There was a higher incidence of episiotomy in the older mothers, but that was the only significant difference.
[7] "Women aged 45 years or more at delivery may expect a good pregnancy outcome but should expect a higher incidences of placental abruption, placenta previa, preeclampsia and caesarean delivery. "
[8] Women 44+ had a higher incidence of pre-eclampsia, gestational diabetes, and assisted or caesarean delivery. However, it seems there was no increase in *emergency* complications of labour itself:
"The incidences of preterm labor, premature rupture of membranes, emergency cesarean delivery, meconium-stained amniotic fluid, small for gestational age newborns, and 5-minute Apgar scores of 7 or lower were not influenced by maternal age."
The finding that emergency caesarean, and babies in poor condition at birth, were not increased is particularly significant for mothers considering home birth.
The study found that older mothers were more likely to have a caesarean if they had received infertility treatment in the past. I wonder whether there might be an element of elective caesarean, or very early recourse to caesarean, in these cases.
[9] Mothers 40+ were more likely to have a miscarriage or abortion, or to have a caesarean. However, they were LESS likely to have preterm rupture of membranes (waters breaking early).
[10] (Berlin, 1997) The caesarean rates in this study are astronomical: "parity has an even greater influence on the mode of delivery than age. Only 30.1% of multi-parae over 40 years underwent surgical delivery (vaginal and abdominal) compared to 77.3% of primiparae. It was also found that multiparae more rarely had surgical delivery than younger primiparae (30-39 years 53.3%, 20-29 years 39.3%)."
Note that the operative delivery rate for first-time mothers in their twenties was 39.3% - what on earth was going on at this unit?? Unlike the results of several other studies mentioned above, the outcome for the baby was relatively poor. Could these two factors possibly be related?
[11] Mothers 45+ were more likely to suffer from pre-eclampsia and gestational diabetes, and to have a baby in an abnormal position.
[12] (USA, 1996) - Mothers 40+ had increased rates of pre-eclampsia and gestational diabetes, and caesarean section, even after the authors accounted for 'physician preference'. However, overall outcomes for the baby were not worse.
[13] (New York, 1996). Mothers 40+ were more likely to have gestational diabetes, pre-eclampsia, placenta praevia - all things which can be diagnosed antenatally. Induction of labour, Caesarean and assisted ('operative vaginal') delivery were also more common. Babies born to older first-time mothers were more likely to be admitted to Special Care or to have low APGAR scores at birth. In multiparas, fetal distress and antepartum haemorrhage were also more likely - which suggests that they were not increased in first-time mothers.
[14] Compared to women aged 20-24, first-timers aged 30+ faced increased risk of premature labour, low birthweight, and late foetal death, but risk for second and subsequent babies was lower. Risks increased for women aged 35+ .
[15] First-time mothers 35+ more likely to have premature labour, low birthweight babies, placental abruption, and c-section.
[16] First-time mothers 35+ face increased risks, but mothers 40+ seem to face no greater risks than those 35+.
[17] USA, 1995. First-timers 30+ have increased c/s rate (28%), but other factors which made c/s more likely were epidural anaesthesia, and social class - suggests that wealthier women were more likely to end up with caesareans.
[18] USA, 1995. First-timers 35+ were more likely to have antenatal risk factors such as gestational diabetes and pre-eclampsia. Regarding the birth itself, there were differences in the rate of preterm birth, low birthweight, malpresentation, induction, caesarean, oxytocin use, and post-partum haemorrhage. [However, note that post-partum haemorrhage rate is higher after induction, oxytocin use, and assisted delivery, and the study does not seem to adjust for these confounding factors].
[19] 'Elderly' primigravidas had up to a 40% combined rate of caesarean section and ventouse delivery, but there was no overall difference in outcome for the baby.
[20] USA, 1993 - "Women of 35 or older are more likely than those in their 20s to have cesarean deliveries. The excess rate of cesarean section is only partially accounted for by gestational complications. " - found that rates of complications such as fetal distress, placenta previa, multiple gestation, abnormal labor, or malpresentation, were only 'modestly higher' in mothers 35+.
[21] Croatia, 1993. Mothers 35+ had increased risk of pre-term or post-term labour, amongst other things. They also had an increased risk of c-section, but the overall rate in mothers 35+ was still only 12.5% (6.8% elective, 5.7% emergency, ie unplanned)!
[22] USA, 1990 - Mothers 35+ had more operative deliveries, but important complications for the mother were no more frequent than for younger age groups. Perinatal mortality was actually lower for this age group, probably because antenatal testing had lead to abortion of foetuses with abnormalities.
[23] It's all downhill from your teenage years... significant association between increasing maternal age and slow progress in labour, induction, caesarean, etc.. The authors suggest that perhaps this reflects a 'progressive, age-related deterioration' in the function of the womb. Looking on the bright side, it shows there is nothing magical about the arbitrary cut-off points of 30, 35 or 40 years used by some authorities to categorise women as 'higher-risk'.
See Abstracts on Older Motherhood, below, for more details of these studies.
US Midwife Archive comments on older mothers:
www.gentlebirth.org/archives/miscPren.html#Older
Website for 35+ mothers - www.mothers35plus.co.uk/
0. British Journal of Obstetrics and Gynaecology, Vol. 108 (9) (2001) pp. 910-918
Can obstetric complications explain the high levels of obstetric interventions and maternity service use among older women? A retrospective analysis of routinely collected data
Jacqueline S. Bell *, Doris M. Campbell, Wendy J. Graham, Gillian C. Penney, Mandy Ryan and Marion H. Hall
Dugald Baird Centre for Research in Women's Health, Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, UK
Objective: To determine whether the higher levels of obstetric intervention and maternity service use among older women can be explained by obstetric complications.
Design: A retrospective analysis of routinely collected data from the Aberdeen Maternity and Neonatal Databank.
Participants: All residents of Aberdeen city district delivering singleton infants at the Maternity Hospital 1988-1997 (28,484 deliveries).
Main outcome measures: Odds ratios for each intervention in older maternal age groups compared with women aged 20-29. Interventions considered include obstetric interventions (induction of labour, augmentation, epidural use, assisted delivery, caesarean section) and raised maternity service use (more than two prenatal scans, amniocentesis, antenatal admission to hospital, admission at delivery of more than five days, infant resuscitation, and admission to the neonatal unit).
Methods: Logistic regression was used to investigate the association between maternal age and the incidence of interventions. The odds ratios for each intervention were then adjusted for relevant obstetric complications and maternal socio-demographic characteristics.
Results: Levels of amniocentesis, caesarean section, assisted delivery, induction, and augmentation (in primiparae) are all higher among older women. Maternity service use also increases significantly with age: older women are more likely to have an antenatal admission, more than two scans, a hospital stay at delivery of more than five days, and have their baby admitted to a neonatal unit. Controlling for relevant obstetric complications reveals several examples of effect modification, but does not eliminate the age effect for most interventions in most groups of women.
Conclusions: Higher levels of intervention among older women are not explained by the obstetric complications we considered.
1. Med J Aust 1994 May 2;160(9):539-44
Delayed childbearing--are there any risks?
Roberts CL, Algert CS, March LM
Northern Sydney Area Public Health Unit, Hornsby Ku-ring-gai Hospital, NSW.
OBJECTIVE: To determine whether women delivering their first child at age 35 years or older are at increased risk of adverse (non-genetic) pregnancy outcomes. DESIGN AND SETTING: A cross-sectional analytic study of singleton deliveries in Northern Sydney Area Health Service (NSAHS) hospitals. PARTICIPANTS: All women aged > or = 20 years delivering their first child between 1 January 1990 and 31 December 1991. MAIN OUTCOME MEASURES: Obstetric complications and procedures, type of delivery and neonatal outcomes.
RESULTS: Compared with women aged 20-29 years, women delivering their first child at > or = 35 years were at increased risk of pre-existing maternal hypertension (adjusted odds ratio [OR], 3.5; 95% confidence interval [CI], 1.7-7.0), antepartum haemorrhage (adjusted OR, 2.4; 95% CI, 1.6-3.7), preterm delivery (33-36 weeks) (adjusted OR, 2.0; 95% CI, 1.5-2.8) and breech presentation (adjusted OR, 1.8; 95% CI, 1.3-2.4). Women aged > or = 35 years were also substantially more likely to have an operative delivery, induced labour and/or epidural anaesthesia. Neither these women nor their infants were at increased risk of pregnancy-induced hypertension, gestational diabetes, threatened premature labour, postpartum haemorrhage, very preterm delivery (< or = 32 weeks), perinatal death, low Apgar scores or the need for neonatal resuscitation. CONCLUSIONS: Women who delay the birth of their first child face some increased risks, but these risks, for the most part, are manageable in the context of modern obstetric care.
PMID: 8164551, UI: 94217504
2. TITLE: Factors contributing to the increased cesarean birth rate in older parturient women.
AUTHORS: Adashek JA; Peaceman AM; Lopez-Zeno JA; Minogue JP; Socol ML
AUTHOR AFFILIATION: Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois.
SOURCE: Am J Obstet Gynecol 1993 Oct;169(4):936-40.
CITATION IDS: PMID: 8238152 UI: 94056550
ABSTRACT: OBJECTIVE: Our purpose was to determine factors contributing to the increased use of cesarean section in patients > or = 35 years old. STUDY DESIGN: Data were collected prospectively on nulliparous patients in spontaneous labor with term, singleton pregnancies and vertex presentations. Criteria for the diagnosis of labor were standardized: regular, painful uterine contractions at least once every 5 minutes in the presence of either complete cervical effacement or spontaneous rupture of membranes. The labors of women > or = 35 years old (n = 74) were compared with those of women 20 to 29 years old (n = 275).
RESULTS: The cesarean section rate was significantly greater for patients > or = 35 years old (21.6% vs 10.2%, odds ratio 2.4, 95% confidence interval 1.2 to 5.1). Mean birth weights were similar in the two groups, but when birth weight was > or = 3600 gm patients > or = 35 years old were more likely to be delivered by cesarean section (36.7% vs 12.2%, odds ratio 4.0, 95% confidence interval 1.4 to 11.9). There were no differences between the two age groups in physician factors that could explain the disparate rates of cesarean delivery. Indeed, of patients delivered vaginally the older parturients received oxytocin for longer duration (6.4 +/- 2.6 vs 5.0 +/- 3.1 hours, p < 0.05) and at higher maximum doses (12.4 +/- 6.1 vs 9.8 +/- 6.2 mU, p < 0.05). After controlling for potentially confounding variables with multiple logistic regression analysis, maternal age (R = 0.125, p < 0.005), birth weight (R = 0.196, p < 0.001), the need for oxytocin (R = 0.210, p < 0.001), and epidural anesthesia (R = 0.195, p < 0.001) were found to be independently associated with the increased rate of cesarean section. CONCLUSION: We could not identify any controllable physician factors affecting the rate of cesarean section in patients > or = 35 years old. The increased oxytocin requirements and the incidence of dystocia with birth weight > or = 3600 gm suggest that maternal and fetal characteristics contribute to the increased frequency of cesarean section in older parturients.
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3.
Influence of parity on the obstetric performance of mothers aged 40 years and above.
AUTHORS: Chan BC; Lao TT
AUTHOR AFFILIATION: Department of Obstetrics & Gynaecology, Tsan Yuk Hospital, Hong Kong Special Administrative Region, People's Republic of China.
SOURCE: Hum Reprod 1999 Mar;14(3):833-7
CITATION IDS: PMID: 10221722 UI: 99236911
ABSTRACT: We reviewed the delivery records of 205 mothers aged 40 years and above who delivered from 1st January 1994 to 31st December 1996 to examine the influence of parity on their obstetric performance. There were 51 (24.9%) primiparous mothers. The incidences of antenatal complications (antepartum haemorrhage, hypertensive disorder, glucose intolerance, prematurity), labour performance (type of labour, mode of delivery) and neonatal outcome (birth weight, Apgar scores, neonatal intensive care unit admission, perinatal mortality) were compared between the 51 (24.9%) primiparous and the 154 (75.1%) multiparous mothers. Higher incidences of antepartum haemorrhage (17.6 versus 5.8%, P = 0.0188), hypertensive disorder (17.6 versus 5.2%, P = 0.015), labour induction (33.3 versus 14.3%, P = 0.004) and Caesarean section delivery (58.8 versus 20.8%, P < 0.0001) were found among the primiparous mothers than the multiparous group. Neonatal outcome, however, was similar in both groups. We conclude that the primiparous mothers aged 40 years and above had more complicated antenatal and labour courses than multiparous mothers. On the other hand, the neonatal outcomes of two groups were comparable.
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4
Do primiparas aged 40 years or older carry an increased obstetric risk?
AUTHORS: Scholz HS; Haas J; Petru E
AUTHOR AFFILIATION: Department of Obstetrics and Gynecology, University of Graz, Austria. scholzhs@.kfunigraz.ac.at
SOURCE: Prev Med 1999 Oct;29(4):263-6
CITATION IDS: PMID: 10547051 UI: 20012542
ABSTRACT: BACKGROUND: It is unclear whether older primiparas are at increased risk for complications of pregnancy other than an increased cesarean section rate. The aim of this study was to compare the rate of complications of pregnancy and delivery of primiparas aged 40 years or older with those of primiparas aged 20 to 30 years.
METHODS: We reviewed the maternal and neonatal hospital records of 59 consecutive primiparas aged 40 years or older who delivered at our institution between 1986 and 1995. A total of 118 primiparas aged 20 to 30 years who preceded and followed the cases served as controls.
RESULTS: The mean duration of gestation was significantly shorter in primiparas > or = 40 years of age. Induction of labor was more common and the cesarean delivery rate was higher (47 vs 12%) in older primiparas. The mean birth weight was significantly lower in the offspring of the cases. The perinatal mortality rate was 5% in the primiparas over 40 years and 0% in the control group; fetal malformations were found in 5% (vs 1%) of the children of older primiparas.
CONCLUSIONS: In our series, older primiparas were at increased risk for prematurity, preeclampsia, and perinatal mortality. The high rate of cesarean section in older primiparas is due mainly to a higher incidence of obstetric complications. These data suggest that the prenatal care of older primiparas in the third trimester should concentrate on the early detection of premature contractions and signs of preeclampsia.
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5.
Elderly nulliparae in midwifery care in Amsterdam.
AUTHORS: Smit Y; Scherjon SA; Treffers PE
AUTHOR AFFILIATION: Department of Obstetrics & Gynaecology, University of Amsterdam, The Netherlands.
SOURCE: Midwifery 1997 Jun;13(2):73-7
CITATION IDS: PMID: 9287659 UI: 97433773
ABSTRACT: OBJECTIVE: to compare labour complications, after an uncomplicated pregnancy, of first births in women 35 years and older with women 20-30 years old. DESIGN: an explorative prospective cohort study. SETTING: four independent midwives' practices in Amsterdam. PARTICIPANTS: a group of 49 elderly nulliparae was compared with a group of 99 younger nulliparae. MEASUREMENTS AND FINDINGS: percentage of referrals and reasons for referral during pregnancy and labour, mode of delivery and obstetric outcome.
KEY CONCLUSIONS: no significant differences in referrals were found between the two compared groups. Obstetric-outcome was not different between the groups, except for a lower birthweight in the elderly group. A trend is seen for a raised percentage of referrals during labour in the older group. This is almost completely explained by a failure to progress during first and second stages of labour. Related to this was a trend for an increased incidence of caesarean section in the older group of women.
IMPLICATIONS FOR PRACTICE: after selection, the elderly nullipara, under the care of a midwife, does not have an increased risk of fetal distress or other emergency factors compared to the younger nullipara. However, the referral rates during labour, both of younger and older women, are high.
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6.
Obstetric outcome of elderly low-risk nulliparae.
AUTHORS: Smit Y; Scherjon SA; Knuist M; Treffers PE
AUTHOR AFFILIATION: Academic Medical Center, University of Amsterdam, The Netherlands. y.smit@amc.uva.nl
SOURCE: Int J Gynaecol Obstet 1998 Oct;63(1):7-14
CITATION IDS: PMID: 9849705 UI: 99064957
ABSTRACT: OBJECTIVE: To compare referrals and reasons for referral during pregnancy and labor, mode of delivery and obstetric outcome of first births in women 35 years and older with women 20-30 years old. METHODS: A prospective cohort study was performed of 146 elderly and 306 younger nulliparae in seven independent midwives' practices in and around Amsterdam. RESULTS: No significant differences in referrals were found between the two compared groups. After selection during pregnancy, obstetric outcome was not different between the groups. A higher percentage of episiotomies was found in the elderly group, compared to the younger group.
CONCLUSIONS: After proper selection during pregnancy, the elderly nullipara under the care of a midwife does not have an increased risk of fetal distress or other emergency factors, compared to the younger nullipara. However, high referral rates during labor - both of younger and older women - were observed in this study.
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7.
Maternal and perinatal outcome of pregnancies after the age of 45.
AUTHORS: Abu-Heija AT; Jallad MF; Abukteish F
AUTHOR AFFILIATION: Department of Obstetrics and Gynaecology, Jordan University of Science and Technology, Irbid, Jordan.
SOURCE: J Obstet Gynaecol Res 2000 Feb;26(1):27-30
CITATION IDS: PMID: 10761327 UI: 20224393
ABSTRACT: OBJECTIVE: To describe the maternal and perinatal outcome of pregnancies in women aged 45 years or more at the time of delivery and to compare them with pregnancies in women aged between 20 and 29 years. METHODS: A retrospective review of hospital deliveries after 28 weeks gestation was performed at the Princess Badeea Teaching Hospital in North Jordan for patients delivered between 1st April 1994 and 31st December 1997. We compared the maternal and perinatal outcome of pregnancies in women aged of 45 years or more (study group, n = 114) with women aged between 20-29 years (control group, n = 121) delivered at the same hospital during the same period.
RESULTS: The incidence of pregnant women aged 45 years or more was 3.3 per 1,000 births. The median maternal age was 45 years. The majority of women (81.6%) were 45 to 46 years old. Gravidity and parity was significantly higher in the study group (p < 0.0001), also antenatal and medical complications as pre-eclampsia and diabetes mellitus were higher in the study group. Caesarean section rate, incidences of placental abruption and placenta previa were more common in older patients compared with young patients (32.4 vs 10.7%, 6.1 vs 0.8% and 4.4 vs 1.6%, respectively). There were no differences in the incidences of neonatal deaths, lethal malformations and fetal weight between the 2 groups.
CONCLUSION: Women aged 45 years or more at delivery may expect a good pregnancy outcome but should expect a higher incidences of placental abruption, placenta previa, preeclampsia and caesarean delivery.
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8.
Effect of very advanced maternal age on pregnancy outcome and rate of cesarean delivery.
AUTHORS: Dulitzki M; Soriano D; Schiff E; Chetrit A; Mashiach S; Seidman DS
AUTHOR AFFILIATION: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.
SOURCE: Obstet Gynecol 1998 Dec;92(6):935-9
CITATION IDS: PMID: 9840553 UI: 99054288
ABSTRACT: OBJECTIVE: To determine outcomes of pregnancies in women at least 44 years of age and to determine factors predicting cesarean delivery in these patients. METHODS: Between January 1988 and December 1995, 109 women at least 44 years old delivered in our medical center. These women were matched to a group of 309 women 20-29 years of age. Multiple logistic regression analysis was used to evaluate the association between maternal age and outcome variables, controlling for possible confounding factors. Based on the logistic regression, a predictive model was calculated for cesarean delivery and validated prospectively in a separate group of 30 consecutive women at least 44 years old, who delivered during the first 8 months of 1996.
RESULTS: Very advanced maternal age, compared with younger age, was associated with a significantly higher rate of medical complications (hypertensive disorder and diabetes) (odds ratio [OR] 2.5; 95% confidence interval [CI] 1.5, 4.1; P < .001), instrument-assisted vaginal delivery (OR 7.5; 95% CI 2.2, 25.0; P < .004), and cesarean delivery (OR 7.3; 95% CI 2.2, 16.7; P < .001). The incidences of preterm labor, premature rupture of membranes, emergency cesarean delivery, meconium-stained amniotic fluid, small for gestational age newborns, and 5-minute Apgar scores of 7 or lower were not influenced by maternal age. The regression model showed an increased risk for cesarean delivery associated with age of at least 44 years (OR 7.3; 95% CI 2.2, 16.7), primiparity (OR 3.5; 95% CI 1.3, 9.8), infertility treatment (OR 3.6; 95% CI 1.5, 8.8), and egg donation (OR 19.5; 95% CI 6.1, 62.2), with positive and negative predictive values of 94 and 86%, respectively.
CONCLUSION: Maternal age of at least 44 years is associated with medical complications in pregnancy and more interventions during labor. However, overall pregnancy outcomes are favorable. Cesarean delivery can be predicted accurately based on maternal age, parity, and infertility treatment.
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9.
[Pregnancy and delivery after 40 years of age]
VERNACULAR TITLE: La gravidanza ed il parto dopo i 40 anni.
AUTHORS: Murgia P; Rao Camemi V; Cadili G
AUTHOR AFFILIATION: Clinica Ostetrica e Ginecologica, Universita degli Studi, Palermo.
SOURCE: Minerva Ginecol 1997 Sep;49(9):377-81
CITATION IDS: PMID: 9446071 UI: 98024764
ABSTRACT: BACKGROUND: In order to study the risks involved with advanced maternal age, pregnancy and delivery of all the women after forty (n = 551) who attended the Obstetrical and Gynecological Clinic of the Palermo University from January 1, 1981 to December 31, 1990 have been examined. MATERIALS AND METHODS: A control group, consisting of women aged 21 to 26 (n = 7980) who attended the Clinic during the same time period, was used for comparison. Each group was analysed for the following parameters: pregnancy complications, time and outcome of deliveries, rate and indications for cesarean section, neonatal outcomes.
RESULTS AND CONCLUSIONS: The results show no significant differences in the factors analysed between the two groups observed, except for an increased rate of abortions and Cesarean sections in the study group and an increased rate of premature rupture of membranes in the control group.
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10.
** "Only 30.1% of multi-parae over 40 years underwent surgical delivery (vaginal and abdominal) compared to 77.3% of primiparae."*** !!!!!!!!!!!!!!!
[Effect of maternal age on the course of labor--analysis of women over 40 years of age]
VERNACULAR TITLE: Einfluss des mutterlichen Alters auf den Geburtsverlauf--Analyse bei Frauen uber 40 Jahre.
AUTHORS: Ragosch V; Altinoz H; Hundertmark H; Entezami M
AUTHOR AFFILIATION: Universitatsfrauenklinik, Klinikum Benjamin Franklin, FU Berlin.
SOURCE: Z Geburtshilfe Neonatol 1997 May-Jun;201(3):86-90
CITATION IDS: PMID: 9303787 UI: 97350229
ABSTRACT: In order to determine the birth risk for pregnant women in the age group > or = 40, the delivery data of 143 pregnant women in this age group were retrospectively evaluated over a 3-year period. Here, 37 of these 143 women (25.9%) were primiparae. The following was examined: The number of prenatal examinations (including ultrasound examinations), the incidence of genetic examinations, the delivery methods with the percentage of surgical deliveries, complications at the time of delivery as well as the fetal outcome with APGAR values, umbilical artery pH, birth weights, neonatal morbidity and mortality. The delivery results were compared with representative populations of women between 20-29 years (n = 2252) and 30-39 years (n = 1980). Pregnancy in older women still ends significantly more often with cesarean section than in younger women. Here, the rate of cesarean sections was 32.7% compared to 21.9% in 30-39-year-olds and 15.8% in 20-29-year-olds. However, parity has an even greater influence on the mode of delivery than age. Only 30.1% of multi-parae over 40 years underwent surgical delivery (vaginal and abdominal) compared to 77.3% of primiparae. It was also found that multiparae more rarely had surgical delivery than younger primiparae (30-39 years 53.3%, 20-29 years 39.3%). Despite the high surgical delivery rate being in the group of primiparae over 40 years, the fetal outcome was comparatively poor, so that the less restrictive indication for surgical delivery seems justified.
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11.
Very advanced maternal age: pregnancy after age 45.
AUTHORS: Dildy GA; Jackson GM; Fowers GK; Oshiro BT; Varner MW; Clark SL
AUTHOR AFFILIATION: Department of Obstetrics and Gynecology, University of Utah School of Medicine, USA.
SOURCE: Am J Obstet Gynecol 1996 Sep;175(3 Pt 1):668-74
CITATION IDS: PMID: 8828432 UI: 96426138
ABSTRACT: OBJECTIVE: Our purpose was to describe the maternal and fetal outcomes of pregnancies in women > or = 45 years old at delivery. STUDY DESIGN: A retrospective review of in-hospital deliveries after 20 weeks of gestation was performed in four Utah tertiary care hospitals for the 10-year period between 1985 and 1994. RESULTS: Seventy-nine cases were identified among 126,500 births, with an incidence of 0.63 per 1000 births. Maternal ages were 45 (n = 44), 46 (n = 21), and > or = 47 (n = 14) years. Three of the conceptions were assisted, including both twin gestations. Thirty-seven (46.8%) had obstetric complications during pregnancy; the most frequent complications were gestational diabetes (12.7%) and preeclampsia (10.1%). Median (range) gestational age at delivery was 39 (22.9 to 41.7) weeks; 12 (15.2%) deliveries occurred before 37 weeks. Eight (9.9%) karyotype abnormalities were diagnosed. The cesarean section rate was 31.7%; the most frequent indications were abnormal lie (n = 9), fetal distress (n = 5), and previous cesarean delivery (n = 5). There were no maternal deaths. Median (range) birth weight was 3466 (397 to 5085) gm; 14 (17.3%) were < 2500 gm and 16 (19.8%) were > 4000 gm. Twelve (14.8%) infants were admitted to the neonatal intensive care unit. The corrected perinatal mortality rate was 1.3% (1/78).
CONCLUSIONS: In women > 45 years old at delivery maternal and fetal outcomes were generally good, but there was a high incidence of pregestational (chronic hypertension, hypothyroidism) and gestational (karyotype abnormalities, gestational diabetes, cesarean section, macrosomia) complications. This information may be helpful for counseling women between 45 and 50 years old who are considering pregnancy.
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12.
Advanced maternal age: perinatal outcome when controlling for physician selection.
AUTHORS: Lagrew DC Jr; Morgan MA; Nakamoto K; Lagrew N
AUTHOR AFFILIATION: Saddleback Memorial Medical Center, Women's Hospital, Laguna Hills, CA 92653, USA.
SOURCE: J Perinatol 1996 Jul-Aug;16(4):256-60
CITATION IDS: PMID: 8866293 UI: 97019838
ABSTRACT: OBJECTIVE: Our purpose was to determine whether differences in maternal outcome because of maternal age could be controlled by the elimination of bias in physician selection. STUDY DESIGN: We performed a case-control study that compared pregnancy outcomes of 164 patients delivered at our institution at > or = 40 years old with outcomes in a control group consisting of the next two deliveries by the same attending physician of women with ages 20 to 29 years. Retrospective analysis of the antepartum and intrapartum records was done to compare clinical outcome.
RESULTS: We observed a significant increased incidence of nulliparous cesarean delivery (p = 0.046), elevated results of glucose screens with a 50 gm load (p = 0.00002), and hypertension throughout pregnancy in the older patients in spite of controlling for physician selection. The older patient group was more likely to have used assisted reproductive techniques (p = 0.000005) and had higher baseline weights (p = 0.001) and maximum pregnancy weights (p = 0.042). However, the neonatal outcome was similar in both groups. Despite controlling for physician selection, we demonstrated increased rates of abdominal delivery, glucose intolerance, and hypertension in older patients. Fetal and neonatal outcomes were similar in both groups.
CONCLUSION: Women > or = 40 years old tend to have an increased incidence of a few pregnancy-related complications, even when controlling for physician selection.
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13.
Pregnancy outcome at age 40 and older.
AUTHORS: Bianco A; Stone J; Lynch L; Lapinski R; Berkowitz G; Berkowitz RL
AUTHOR AFFILIATION: Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai Medical Center, New York, New York, USA.
SOURCE: Obstet Gynecol 1996 Jun;87(6):917-22
CITATION IDS: PMID: 8649698 UI: 96240566
ABSTRACT: OBJECTIVE: To examine pregnancy outcome among women age 40 years and older. METHODS: A retrospective cohort study, including 1404 pregnant women at least 40 years of age and 6978 controls age 20-29 years, was conducted. The two groups were stratified, according to parity, to facilitate separate analysis. Associations between maternal age and pregnancy outcomes were assessed with the contingency chi 2 or two-tailed Fisher exact test. Multiple logistic regression was used to evaluate these associations and allowed for calculation of adjusted odds ratios (OR).
RESULTS: Older gravidas were more likely to develop gestational diabetes (nulliparas: OR 2.7, 95% confidence interval [CI] 1.9-3.7; multiparas: OR 3.8, 95% CI 2.7-5.4), preeclampsia (nulliparas: OR 1.8, 95% CI 1.3-2.6; multiparas: OR 1.9, 95% CI 1.2-2.9), and placenta previa (nulliparas: OR 13.0, 95% CI 4.8-35.0; multiparas: OR 6.4, 95% CI 2.6-15.6). Older women were also at increased risk for cesarean delivery (nulliparas: OR 3.1, 95% CI 2.6-3.7; multiparas: OR 3.3, 95% CI 2.6-4.1), operative vaginal delivery (nulliparas: OR 2.4, 95% CI 1.9-2.9; multiparas: OR 1.5, 95% CI 1.2-1.9), and induction of labor (nulliparas: OR 1.5, 95% CI 1.2-1.8; multiparas: OR 1.4, 95% CI 1.1-1.7). Older nulliparas had an increased incidence of abnormal labor patterns (OR 1.4, 95% CI 1.2-1.7), neonatal intensive care unit admissions (OR 1.6, 95% CI 1.2-2.2), and low 1-minute Apgar scores (OR 2.3, 95% CI 1.1-4.9). Older multiparas were more likely to experience fetal distress (OR 2.0, 95% CI 1.4-2.8), antepartum vaginal bleeding (OR 1.8, 95% CI 1.1-3.1), and preterm premature rupture of membranes (OR 1.7, 95% CI 1.1-2.9).
CONCLUSION: Although maternal morbidity was increased in the older gravidas, the overall neonatal outcome did not appear to be affected.
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14.
Do delayed childbearers face increased risks of adverse pregnancy outcomes after the first birth?
AUTHORS: Cnattingius S; Berendes HW; Forman MR
AUTHOR AFFILIATION: Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
SOURCE: Obstet Gynecol 1993 Apr;81(4):512-6
CITATION IDS: PMID: 8459958 UI: 93211607
ABSTRACT: OBJECTIVE: To investigate whether the age-related risk of adverse pregnancy outcomes in the first birth persisted in the second birth, before and after adjusting for the influence of an adverse pregnancy outcome in the first birth and for other possible confounders. METHODS: Prospectively collected longitudinal data from the Swedish Medical Birth Registry (n = 210,735 women) were analyzed to contrast the effects of maternal age at the first birth on the risk of adverse pregnancy outcomes in the first and second successive births. RESULTS: Rates of adverse pregnancy outcomes were substantially higher in first than in second births. Compared with women aged 20-24, women aged 30-34 years had significantly higher odds ratios (ORs) of late fetal death (OR 1.4) and early neonatal death (OR 1.4) for the first but not for second births; women aged 35+ had a significantly higher OR of late fetal death (OR 2.2) for the first but not for second births. Women over 35 also had a significantly higher OR of early neonatal death for the first birth (OR 2.8) and less of an increase for second births (OR 1.8), a higher OR of low birth weight (LBW) for the first (OR 1.5) and second births (OR 1.6), and a higher OR of preterm birth for the first (OR 1.4) and second births (OR 1.7). Despite the strong tendency to repeat an adverse pregnancy outcome in second births, the age-related ORs did not change with adjustment for the previous pregnancy outcome.
CONCLUSION: Women aged 30+ at their first births have increased risks of adverse pregnancy outcomes in first births. However, second births showed no age-related increase in late fetal death and a smaller increase in early neonatal death. Increased risks for LBW and preterm birth were similar for first and second births of delayed childbearers.
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15
Adverse perinatal outcome in the older primipara.
AUTHORS: Dollberg S; Seidman DS; Armon Y; Stevenson DK; Gale R
AUTHOR AFFILIATION: Department of Neonatology, Bikur Cholim Hospital, Jerusalem, Israel.
SOURCE: J Perinatol 1996 Mar-Apr;16(2 Pt 1):93-7
CITATION IDS: PMID: 8732554 UI: 96311132
ABSTRACT: Delayed childbearing has become common and has raised the awareness of the possible risks for the mother and the newborn infant. The increased maternal and neonatal risks have been attributed largely to the lack of proper prenatal care. The aim of this study was to assess whether advanced maternal age is a significant risk factor in mothers who receive good prenatal care. We matched 161 cases 1:1 according to the following criteria: maternal and paternal ethnic origin, chronic diseases, marital status, and smoking during pregnancy. Our results show that the older women had babies with a significantly higher incidence of low birth weight (< 2500 gm, p = 0.001), prematurity (< 37 weeks, p = 0.02), intrauterine growth retardation (p = 0.001), abruptio placentae (p = 0.002), and cesarean section (p < 0.001). The average hospital stay for the babies of the older mothers was longer than that for babies of the younger mothers (8.4 vs 6.1 days, p = 0.003), and the incidence of hospitalization for more than 3 days in the neonatal intensive care unit was increased (10.3% vs 2.2%). Logistic regression did not support maternal age of 35 years and older as being the single significant risk factor for adverse neonatal and maternal outcome. We conclude that maternal age older than 35 years entails a higher risk for the mother and her newborn infant, even when good prenatal care is taken.
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16.
High delivery intervention rates in nulliparous women over age 35.
AUTHORS: Ezra Y; McParland P; Farine D
AUTHOR AFFILIATION: Division of Perinatology, Mount Sinai Hospital, Toronto, Canada.
SOURCE: Eur J Obstet Gynecol Reprod Biol 1995 Oct;62(2):203-7
CITATION IDS: PMID: 8582496 UI: 96149892
ABSTRACT: OBJECTIVE: To assess the effect of maternal age and parity on obstetric interventions and pregnancy outcome. STUDY DESIGN: A retrospective review of 35,140 deliveries including 4268 parturients aged 35 years or more (1985-1992). Obstetrical interventions and outcome were analyzed in relation to age and parity. RESULTS: Nulliparous women aged 35 years or more had a 2-fold increase in cesarean delivery rate over younger nulliparae, and 50% more cesarean deliveries than the multiparae aged 35 years or more. Similar trends were observed in preterm labor, labor induction, breech presentation, and instrumental delivery. Higher risk was encountered in neonatal 1 min Apgar scores < 3, and in admissions to the neonatal intensive care unit. There were no differences in all parameters between women over age 40 and women aged 35-40 years. The perinatal mortality was not increased and was similar in all groups. CONCLUSIONS: Nulliparae aged more than 35 years are at increased risk for interventions and cesarean sections. However, women aged 35-40 have a similar risk as women aged over 40 years.
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[17]
Maternal age and labor complications in healthy primigravidas at term.
AUTHORS: Albers LL; Lydon-Rochelle MT; Krulewitch CJ
AUTHOR AFFILIATION: University of New Mexico College of Nursing, Albuquerque 87131-1061.
SOURCE: J Nurse Midwifery 1995 Jan-Feb;40(1):4-12
CITATION IDS: PMID: 7869149 UI: 95173726
ABSTRACT: The objective of this study was to describe the association between maternal age and selected risk indicators (both recognized and potential) to determine whether any were predictive of labor complications in women having a first child. Low-risk primigravidas (n = 1,792) were selected from a large national probability sample of births for 1988 (the National Maternal and Infant Health Survey). Recognized and potential risk indicators were described according to categories of maternal age and the occurrence of labor problems. Stratified analysis and logistic regression were used to assess the association of various risk factors with labor complications adjusted for maternal age. Only cesarean delivery varied significantly across maternal age groups, the rate being 11.6% for those < 20, 15.9% for those age 20-29, and 28.3% for those > or = 30. Cesarean delivery was associated with several characteristics of social advantage. Independent risk factors for cesarean delivery were maternal age (particularly > or = 30), epidural anesthesia, and receipt of adequate prenatal care. We conclude that older primigravidas have significantly more cesarean deliveries, and this is partially explained by characteristics of social advantage. To address the high cesarean rate, care providers need a better understanding of the relationship between social circumstances and cesarean delivery.
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[18]
Pregnancy outcome in nulliparous women 35 years and older.
AUTHORS: Prysak M; Lorenz RP; Kisly A
AUTHOR AFFILIATION: Department of Obstetrics and Gynecology, St. John Hospital, Detroit, Michigan.
SOURCE: Obstet Gynecol 1995 Jan;85(1):65-70
CITATION IDS: PMID: 7800328 UI: 95098444
ABSTRACT: OBJECTIVE: To compare pregnancy and delivery complications of first births in women 35 years and older with women 25-29 years old. METHODS: Maternal and newborn records for first births at three suburban hospitals from July 1, 1986 to June 30, 1990 were studied retrospectively.
RESULTS: The older women differed significantly in: 1) antepartum factors (type of insurance, marital status, prior pregnancy experience, weight gain, obesity, chronic and pregnancy-induced hypertension, gestational diabetes [without insulin], asthma, leiomyomas; and third-trimester bleeding), 2) intrapartum factors (anesthesia for vaginal delivery, gestational age at delivery, preterm labor, spontaneous labor, oxytocin use, malpresentation, cesarean births, and postpartum hemorrhage), and 3) neonatal outcomes (gestational age, birth weight, preterm births, abnormal karyotypes, neonatal intensive care unit admissions, low birth weight, and small for gestational age infants). Logistic regression determined that risk factors significantly predicting perinatal mortality were leiomyomas (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.3-5.0), preterm birth (OR 4.9, 95% CI 3.1-7.7), and chorioamnionitis (OR 5.9, 95% CI 3.1-11.4), but not age.
CONCLUSION: Nulliparous women 35 years and older had higher rates of antepartum, intrapartum, and newborn complications than nulliparas between the ages of 25-29 years, but not an increased perinatal mortality rate. Despite the increased risk of complications, maternal and perinatal outcomes were good.
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[19]
[The older primipara--an obstetrical risk group?]
VERNACULAR TITLE: Die spate Erstgebarende--Ein geburtshilfliches Risikokollektiv?
AUTHORS: Seufert R; Casper F; Krass A; Brockerhoff P
AUTHOR AFFILIATION: Universitatsfrauenklinik Mainz.
SOURCE: Zentralbl Gynakol 1994;116(3):169-72
CITATION IDS: PMID: 8178598 UI: 94233897
ABSTRACT: While the number of the "elderly primigravida" seems to increase in some perinatal centers, we compared pregnancy, delivery mode and fetal outcome of 416 patients with a matched pair group of 15 year younger primigravida. While the rate of caesarean section and vacuum extraction rises up to 40%, we could not found any difference for the fetal outcome. Though we conclude that modern perinatal management in case of the elderly primigravida is very effective and allows normal fetal outcome.
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[20]
Pregnancy outcome in nulliparous women aged 35 or older.
AUTHORS: Edge V; Laros RK Jr
AUTHOR AFFILIATION: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco 94143-0132.
SOURCE: Am J Obstet Gynecol 1993 Jun;168(6 Pt 1):1881-4; discussion 1884-5
CITATION IDS: PMID: 8317536 UI: 93304467
ABSTRACT: OBJECTIVE: Our objective was to test the hypothesis that pregnancies beyond 20 weeks in women aged 35 or older are high-risk pregnancies.
STUDY DESIGN: Pregnancies of 857 women aged 35 and older were compared with pregnancies of 1597 women aged 20 to 29 with respect to pregnancy complications and outcome. All women received prenatal care and were delivered at our institution. Data were collected prospectively and stored in a data base. The chi 2 test was used to identify trends in individual variables and outcomes. Logistic regression analysis was used to examine the relationship between maternal age and delivery by cesarean section.
RESULTS: Women aged 35 or older had cesarean deliveries twice as often as women 20 to 29 years old. This statistically significant difference was not accounted for by the modestly higher rates of fetal distress, placenta previa, multiple gestation, abnormal labor, or malpresentation found in the older group. Cord blood gas values and 5-minute Apgar scores did not differ between the two groups. There was no difference in neonatal morbidity or mortality.
CONCLUSIONS: Women of 35 or older are more likely than those in their 20s to have cesarean deliveries. The excess rate of cesarean section is only partially accounted for by gestational complications.
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[21]
Pregnancy and delivery in women aged 35 years and over.
AUTHORS: Mikulandra F; Perisa M; Merlak I; Stojnic E; Balic J
AUTHOR AFFILIATION: Department of scientific research, Medical center of Sibenik, Croatia.
SOURCE: Zentralbl Gynakol 1993;115(4):171-6
CITATION IDS: PMID: 8503236 UI: 93276650
ABSTRACT: At the Medical Centre Department of Gynaecology and Obstetrics in Sibenik there were 26 116 deliveries over the 1970-1991 period, of which 1502 (5.75%) occurred in women aged 35 years and older. Among them 254 (0.97%) were primiparas, 1074 (4.11%) multiparas (two to four deliveries) and 174 (0.6%) grand multiparas (five deliveries and more). The control group consisted of 7920 primiparas, 7920 multiparas (two to four deliveries) and 80 grand multiparas (five deliveries and more) aged 20 to 34 years. There was no difference for occupation between the two groups (P > 0.05), whereas rural women (59.5%), unmarried women (4.2%), women with spontaneous (21.0%) or induced abortions (23.3%) were more common in the study group (P < 0.001). No antenatal visit received 5.9% and 1.8% (P < 0.001) in the study and control groups, respectively; the mean number of antenatal visits was 6.05 +/- 3.20 and 6.26 +/- 3.12, respectively (t = 2.41, P < 0.05). Threatened abortion (16.8%), EPH gestosis (9.5%), cervical cerclage (5.8%), weight gain above 14 kg (9.8%), preterm labour (8.4%), delivery at > or = 42 weeks (3.1%), premature rupture of the membranes (16.4%), meconium-stained amniotic fluid (14.4%), and up to 6-hour duration of labour (73.2%, elective caesarean section (6.8%), emergency caesarean section (5.7%), vacuum extraction (3.8%) and placental lysis or uterine exploration (3.8%) were more common in women > or = 35 years of age (P < 0.05). Higher rates for 7-to-12-hour duration of labour (33.6%) and episiotomy (64.2%) were found in the control group (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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[22]
Impact of advanced maternal age on the outcome of pregnancy.
AUTHORS: Ales KL; Druzin ML; Santini DL
AUTHOR AFFILIATION: Department of Internal Medicine, New York Hospital-Cornell University Medical Center, New York 10021.
SOURCE: Surg Gynecol Obstet 1990 Sep;171(3):209-16
CITATION IDS: PMID: 2385814 UI: 90350074
ABSTRACT: We assessed the impact of advanced maternal age on the outcome of pregnancy by studying all 1,328 women who were primarily cared for and delivered at our institution between 14 September 1984 and 12 February 1985. Important peripartum maternal complications were no more frequent in women aged 35 years or more than in women 20 to 34 years old, although operative delivery was significantly more common. Similarly, adverse outcomes of infants were no more frequent. Perinatal mortality tended to be lower. In addition, we noted a trend for fewer infants with congenital anomalies to be born among older women. This trend was related, in part, to the choice to terminate the pregnancy by women with fetuses that had documented chromosomal anomalies. We conclude that advanced maternal age was not associated with an excess of adverse pregnancy outcome and suggest that, with early registration and careful surveillance during pregnancy, women aged 35 years or more can experience excellent pregnancy outcomes.
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[23]
Br J Obstet Gynaecol 1998 Oct;105(10):1064-9
Is there an incremental rise in the risk of obstetric intervention with increasing maternal age?
Rosenthal AN, Paterson-Brown S.
Queen Charlotte's and Chelsea Hospital for Women, London, UK.
OBJECTIVE: To determine whether increasing maternal age increases the risk of operative delivery and to investigate whether such a trend is due to fetal or maternal factors. DESIGN ANALYSIS: of prospectively collected data on a maternity unit database. SETTING: A postgraduate teaching hospital. POPULATION: 6410 nulliparous women with singleton cephalic pregnancies delivering at term (3742 weeks of gestation) between 1 January 92 and 31 December 95. MAIN OUTCOME MEASURES: Mode of delivery, rates of prelabour caesarean section, induction of labour and epidural usage. RESULTS: There was a positive, highly significant association between increasing maternal age and obstetric intervention. Prelabour (P < 0.001) and emergency (P < 0.001) caesarean section, instrumental vaginal delivery (spontaneous labour P < 0001; induced labour P = 0.001), induction of labour (P < 0.001) and epidural usage in spontaneous labour (P = 0.005) all increased with increasing age. In the second stage of labour fetal distress and failure to advance, requiring instrumental delivery, were both more likely with increasing maternal age (in both P < 0.001). Epidural usage in induced labour and the incidence of small for gestational age newborns did not increase with increasing maternal age (P = 0.68 and P = 0.50, respectively). CONCLUSIONS: This study demonstrates that increasing maternal age is associated with an incremental increase in obstetric intervention. Previous studies have demonstrated a significant effect in women older than 35 years of age, but these data show changes on a continuum from teenage years. This finding may reflect a progressive, age-related deterioration in myometrial function.
PMID: 9800928 [PubMed - indexed for MEDLINE]
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